Immunotherapy Landscape for Acute Lymphoblastic Leukaemia (ALL) in Malaysia: A Qualitative Study Among Healthcare Professionals From Two National Referral Centres
Mei Pin Ngu, Noorasyikin Shamsuddin, Hasniza Zaman Huri, Wei Lim Chong, Izyan A WahabIntroduction
Relapsed or refractory B-cell acute lymphoblastic leukaemia (B-ALL) carries a poor prognosis in adults. Although immunotherapies have expanded treatment options, access to these life-extending therapies remains a challenge in many resource-constrained healthcare systems. This study explored healthcare professionals’ perspectives on the immunotherapy landscape for adult B-ALL in Malaysia’s public sector.
Methods
A qualitative study was conducted using in-depth, semi-structured interviews with 11 healthcare professionals from two tertiary centres in Malaysia. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis.
Results
Six themes characterised the current implementation landscape. While the clinical benefits of immunotherapy were widely recognised, its use remained largely restricted to salvage or bridging therapy. Financial constraints, fragmented funding mechanisms, administrative burden, infrastructure constraints, limited clinical expertise or experience, and the absence of standardised treatment pathways hindered wider integration into routine care. These collectively contributed to inequitable access and delayed treatment initiation in a setting of a rapidly progressive disease.
Conclusions
Healthcare professionals recognise the therapeutic value of immunotherapy for adult B-ALL, but its implementation in Malaysia’s public sector remains selective and constrained. Systemic reforms across funding, formulary policy, workforce development, and clinical governance may be needed to close the gap between therapeutic potential and patient outcomes.