High-dose chemotherapy followed by autologous haematopoietic rescue is widely used in the treatment of patients with paediatric malignancies. It is now well established as a major component for the treatment of children with metastatic neuroblastoma over the age of one at diagnosis. Its place for other tumours, such as metastatic Ewing and rhabdomyosarcoma, needs to be better established. In the future, high-dose chemotherapy may replace cranio-spinal irradiation in the treatment of medulloblastoma in young children and represent a major tool for retrieval therapy in relapsing Wilm's and retinoblastoma. More co-operative studies are needed in order to clarify the population of patients who may most benefit from this approach and to determine the optimal chemotherapy regimen needed for each disease.