nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.21682/2311-1267-2026-13-1-60-68nodgo-1264Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSCAR-T- и CAR-NK-терапия в педиатрической онкологии: возможности и вызовыCAR-T and CAR-NK therapies in pediatric oncology: opportunities and challengeshttps://orcid.org/0009-0004-1643-4265АббасоваФ. М.AbbasovaF. M.

студентка

119048, Москва, ул. Трубецкая, 8, стр. 2

Student

Bldg. 2, 8 Trubetskaya St., Moscow, 119048

aspirant02@bk.ruhttps://orcid.org/0009-0005-8190-9658АлиеваР. Э.AlievaR. E.

студентка

119048, Москва, ул. Трубецкая, 8, стр. 2

Student

Bldg. 2, 8 Trubetskaya St., Moscow, 119048

ruba.alieva.200@inbox.ruhttps://orcid.org/0009-0002-6983-5041КиталаевК. З.KitalaevK. Z.

ординатор

367000, Махачкала, пл. Ленина, 1

Resident

1 Lenin Square, Makhachkala, 367000

kitalaev.k@mail.ruhttps://orcid.org/0000-0001-6006-8136ПоляковаО. В.PolyakovaO. V.

к.м.н., доцент, доцент кафедры детских болезней педиатрического факультета

400131, Волгоград, пл. Павших Борцов, 1

Cand. of Sci. (Med.), Associate Professor, Associate Professor of the Department of Pediatric Diseases, Faculty of Pediatrics

1 Fallen Fighters Square, Volgograd, 400131

olpolyakova@gmail.comФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)Russian FederationФГБОУ ВО «Дагестанский государственный медицинский университет» Минздрава РоссииРоссияDagestan State Medical University of the Ministry of Health of RussiaRussian FederationФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава РоссииРоссияVolgograd State Medical University of the Ministry of Health of RussiaRussian Federation2026030420261316068Copyright © Аббасова Ф.М., Алиева Р.Э., Киталаев К.З., Полякова О.В., 20262026Аббасова Ф.М., Алиева Р.Э., Киталаев К.З., Полякова О.В.Abbasova F.M., Alieva R.E., Kitalaev K.Z., Polyakova O.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/1264

Злокачественные заболевания у детей остаются одной из наиболее сложных областей современной онкологии, где даже существенный прогресс в диагностике и стандартных методах лечения не всегда позволяет добиться стойкого контроля над болезнью. За последнее десятилетие особое внимание привлекли клеточные иммунные технологии – прежде всего методы терапии CAR-T- и CAR-NK-клетками, которые открыли возможности точечного воздействия на опухоль и продемонстрировали беспрецедентную эффективность при рецидивирующих В-клеточных лейкозах. CAR-T-клетки позволили изменить прогноз для пациентов, утративших чувствительность к традиционным схемам терапии, а CAR-NK-клетки представили перспективу более безопасной, потенциально универсальной платформы. Однако успешные результаты применения этих технологий при гематологических заболеваниях резко контрастируют с трудностями их использования при солидных опухолях и редких детских онкопатологиях. Гетерогенность антигенов, особенности опухолевой микросреды, низкая инфильтрация и недостаточная персистенция клеток остаются основными барьерами, ограничивающими расширение показаний. Дополнительные вызовы создают иммунотоксичность, вариабельность клинических исходов и сложности производства клеточных продуктов, особенно в педиатрии. В обзоре рассматриваются ключевые механизмы действия методов CAR-терапии, особенности их эффективности и безопасности у детей, а также современные стратегии повышения результативности – от мультиантигенных и тандемных конструкций до комбинированных подходов и методов персонализированного мониторинга. Особое внимание уделяется направлениям будущих исследований, включая биомаркеры ответа, мониторинг минимальной остаточной болезни и интеграцию клеточных технологий с другими видами терапии.

Malignant diseases in children remain one of the most difficult areas of modern oncology, where even significant progress in diagnosis and standard treatment methods does not always allow for stable disease control. Over the past decade, cellular immune technologies have attracted special attention, primarily CAR-T and CAR-NK therapies, which have opened up the possibilities of targeted effects on tumors and demonstrated unprecedented effectiveness in recurrent B-cell leukemias. CAR-T cells made it possible to change the prognosis for patients who have lost sensitivity to traditional therapy regimens, and CAR-NK presented the prospect of a safer, potentially universal platform. However, the successful results in hematological diseases contrast sharply with the difficulties of using these technologies in solid tumors and rare childhood oncopathologies. Heterogeneity of antigens, features of the tumor microenvironment, low infiltration and insufficient cell persistence remain the main barriers limiting the expansion of indications. Additional challenges include immunotoxicity, variability in clinical outcomes, and complexity in the production of cellular products, especially in pediatrics. The review examines the key mechanisms of action of CAR-therapies, the specifics of their effectiveness and safety in children, as well as modern strategies for improving effectiveness, from multiantigenic and tandem designs to combined approaches and methods of personalized monitoring. Particular attention is being paid to areas of future research, including response biomarkers, monitoring of minimal residual disease, and integration of cellular technologies with other therapies.

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The authors declare that there are no conflicts of interest present.