Recent studies suggest that the administration of intensive post-remission therapy, which includes high-dose cytarabine, results in a longer period of disease-free survival when compared with lower dose treatment. In view of these improved results, it is uncertain currently whether younger patients with acute myeloid leukemia (AML) in first remission should be offered such intensive chemotherapy or either allogeneic or autologous bone marrow transplantation. Currently ongoing clinical trials, laboratory-based prognostic factor analysis, and attempts at better understanding the pathophysiology of acute leukemia may provide more precise guidelines for choosing the best treatment among these alternatives for any given individual with AML in first remission.