Multiple myeloma (MM) is the most common hematological malignancy in Western countries.Although there are numerous effective treatments for MM today, these novel agents are often very expensive and inaccessible to many patients in poorer Asian countries.Moreover, several Asian physicians have anecdotally mentioned that the doses of anti-MM drugs in Western treatment regimens are frequently unsuitable for Asian patients-whether too high or too low.Hence, there is a pressing need for Asian doctors to find effective and affordable anti-MM treatments for their patients.Since the incidence of MM is relatively lower in Asia, clinical trials for MM in Asia can better succeed through collaborative efforts.To the best of our knowledge, our study is first Asia-Pacific cooperative clinical trial in MM (the DAZZLE Study).Physicians from 4 countries (Malaysia, India, Singapore and South Korea) joined to conduct this single-arm non-randomized open-labeled phase Ⅱ multicenter clinical trial.The "dtZ" regimen was crafted in Singapore and includes low doses of Dexamethasone (Dex) and Thalidomide (Thal);but the most frequent approved dosing frequency of Zoledronic Acid (Zol).Forty-four newly-diagnosed Asian MM patients received up to 6 cycles of"dtZ" every 3 weeks.We found that Asian MM patients could only tolerate 35-45% of the doses Dex and/or Thal as compared to Western MM patients.Asian MM patients could tolerate the maximum approved dose of Zol (4 mg every 3-weeks) with no reports of nephrotoxicity or osteonecrosis of the jaw (ONJ).Despite the very low doses of Dex/Thal, response rates were reasonably good-88.6% showed at least a partial response (PR);and 34.1% achieved complete response (CR) or near CR (nCR).Achievement of CR/nCR was significantly correlated with robust and sustained suppression of urinary N-telopeptide (uNTx) excretion;as well as decrease in the absolute monocyte count (AMCO), which is a surrogate marker of the pre-osteoclast (pOC) pool.These data support the role of Zol as a mediator of a clinically-relevant anti-MM effect.Because the cost of"dtZ" is <10% that of regimens like VELCADE-REVLIMIDDex, "dtZ" is possibly a very cost-effective regimen for Asian patients with MM.This has significant economic implications in most Asian countries, especially in the context of managing rising healtheare costs.We therefore conclude that the "dtZ" regimen, which is customized for the Asian patient with MM, can be considered for use as a very effective, safe and more affordable first-line regimen.