There has been considerable progress in the understanding and treatment of childhood acute myeloid leukaemia over the past two decades. In particular, cyto- and molecular genetics offer the potential for more specific diagnosis of what is basically a heterogeneous disease. To date treatment has been based on a steady increase in cytotoxic chemotherapy with or without the addition of bone marrow transplantation. Randomised therapeutic trials are difficult to perform in what is a rare disease. The best way forward is for paediatric trial groups worldwide to collaborate in developing common, or parallel, therapeutic protocols.