DNMT3A and acute lymphoblastic leukemia: This study analyzes two cases of ICANS to explore the challenges in recognizing clinical symptoms and standardizing management.<h4>Case presentation</h4>Case 1 involved a 69-year-old male with B-ALL, harboring <i>TP53</i> and <i>DNMT3A</i> mutations, who developed grade 2 ICANS following blinatumomab treatment.