FIGURE 7.

Other potentially relevant factors in immune effector cell‐associated neurotoxicity syndrome (ICANS) after chimeric antigen receptor T‐cell (CAR‐T) treatment. Previous cerebral disease may potentiate neuronal response to stimulus with increased neuronal excitability. CD19 expression on pericyte and CD22 expression on microglia may induce on‐target off‐tumor effect by CAR‐T cell that contributes to blood–brain barrier (BBB) dysfunction and CNS inflammation. Tocilizumab application in patients with cytokine release syndrome (CRS) after CAR‐T treatment may promote peripheral free IL‐6 accumulation and infiltration into the central nervous system (CNS) in absence of tocilizumab penetrating through BBB. Astrocyte swelling with endfoot process disruption and clasmatodendrosis compromises its fluid exchange between the peripheral blood and CNS.