Cytosine arabinoside (Ara-C) is one of the most active drugs in the treatment of adult acute myeloid leukemia and is widely applied at all phases of therapy. In spite of its extensive clinical use, controversies exist about the most appropriate way and dose of intravenous administration: continuous or bolus infusion and standard-, intermediate- or high-dose. The present review focuses on the role and place of each modality of administration of Ara-C and on the potential interest on hematopoietic growth factors recently given concomitantly to Ara-C therapy. Based on available clinical and experimental data, the following conclusions can be drawn: conventional continuous infusion Ara-C-based regimens remain the standard therapy regarding first remission induction. The use of high-dose Ara-C has been followed by improved results in patients with slow initial cytoreduction after a first course of treatment and is an interesting approach for consolidation protocols. In relapsed and refractory adult acute myeloid leukemia, higher than conventional doses undoubtedly enhance the efficacy of Ara-C salvage therapy. Encouraging results emerge from the association of hematopoietic growth factors administered concomitantly to Ara-C based regimens, which need confirmation in prospective randomized placebo controlled comparative trials.