The genetics of primary dysmenorrhoea: a systematic review.

B-cell acute lymphoblastic leukaemia (B-ALL) is an aggressive haematological malignancy characterised by uncontrolled proliferation of immature B-cell lymphoblasts in the bone marrow, peripheral blood, and extramedullary sites. In adults, treatment is further influenced by Philadelphia chromosome status, with distinct considerations for Philadelphia chromosome-positive (Ph) and Philadelphia chromosome-negative (Ph) ALL. Although outcomes in adults have historically been poor, particularly in the relapsed or refractory setting, the treatment landscape has been transformed by immunotherapies including blinatumomab, inotuzumab ozogamicin, and chimeric antigen receptor T (CAR-T) cell therapies. These therapies have improved remission rates and survival outcomes, and have shown promise as bridging strategies to hematopoietic stem cell transplantation. Recent National Comprehensive Cancer Network (NCCN) guidelines further support the incorporation of blinatumomab into first-line treatment for selected adults with newly diagnosed B-ALL, marking a shift towards immunotherapy-containing regimens. However, the translation of these advances into routine clinical practice in Malaysia remains uneven. Globally, the integration of immunotherapy into cancer care is not only supported by clinical efficacy but also by health system capacity, financing, infrastructure, and workforce readiness. In low- and middle-income countries, access to immunotherapy varies largely across settings and is often concentrated in specialised centres. High treatment costs and the need for specialised infrastructure and trained personnel are key barriers to implementation. These challenges reflect the gap between therapeutic innovation and real-world access, which is further widened by reimbursement and health system processes even in high-income settings. Across Asia, differences in healthcare financing, infrastructure, and policy priorities influence access. High-income systems such as Japan and South Korea have more established access and clinical infrastructure, while China has rapidly expanded immunotherapy research, particularly in CAR-T therapy through investment and policy initiatives. Malaysia, an upper-middle-income country, occupies a transitional position between resource-constrained and high-income health systems. Persistent challenges in affordability, diagnostic capacity, geographic access, and health-system resources continue to shape the availability and delivery of these novel treatments. In adult B-ALL, the adoption of immunotherapy remains at an early and evolving stage. Although blinatumomab has been registered in Malaysia, access to other advanced modalities such as CAR-T therapy remains limited. Local experience with Malaysian-manufactured CAR-T product suggests emerging domestic capacity in immunotherapy development. However, CAR-T therapy has yet to be established as a part of routine clinical practice for adult B-ALL in Malaysia, with access reported mainly through clinical trials or individual case-by-case approvals. These limitations are consistent with broader challenges reported in the management of rare diseases and the implementation of cell and gene therapy products (CGTPs) in Malaysia, along with funding constraints and the lack of sufficient specialised infrastructure.