When You Can't Get Revumenib: What Are Your Options?

If you've been prescribed Revumenib (brand name Revuforj) for relapsed or refractory acute leukemia and you're having trouble filling your prescription, you may be wondering what other treatments are available. Whether the delay is due to prior authorization, specialty pharmacy access, or cost, knowing your alternatives is important.

Let's be clear upfront: you should never stop or change your treatment without talking to your oncologist. This article is meant to help you have an informed conversation with your care team — not to replace their medical advice.

What Is Revumenib and How Does It Work?

Revumenib is a menin inhibitor — the first drug in its class to receive FDA approval. It was approved in November 2024 for the treatment of relapsed or refractory acute leukemia with a KMT2A translocation, and its approval was expanded in October 2025 to include relapsed or refractory acute myeloid leukemia (AML) with a susceptible NPM1 mutation.

The drug works by blocking the interaction between menin (a protein) and KMT2A fusion proteins. In certain types of leukemia, this interaction drives cancer cell growth. By disrupting it, Revumenib helps leukemia cells stop multiplying and begin to mature normally.

For a deeper explanation, see our article on how Revumenib works.

Revumenib is taken orally as a tablet, typically 270 mg twice daily for patients not taking strong CYP3A4 inhibitors. It costs approximately $39,500 per month at wholesale acquisition cost.

Why You Might Need an Alternative

There are several reasons patients may need to explore alternatives to Revumenib:

• Access delays — Specialty pharmacy distribution and prior authorization can take weeks
• Insurance denials — Some plans may deny coverage or require step therapy
• Side effects — Revumenib carries boxed warnings for differentiation syndrome and QTc prolongation, which may be concerns for some patients
• Cost — At nearly $474,000 per year, even with insurance, copays can be significant
• Clinical factors — Your oncologist may determine that another treatment is better suited to your specific situation

Alternative Treatments for KMT2A-Rearranged and NPM1-Mutated Leukemia

While Revumenib is the only FDA-approved menin inhibitor, there are several other treatment approaches your oncologist may consider. Here are the most relevant alternatives in 2026.

1. Ziftomenib (Investigational)

Ziftomenib is another menin inhibitor currently in late-stage clinical trials. Studied in the KOMET-001 trial, Ziftomenib has shown meaningful efficacy at a 600 mg dose in heavily pretreated patients with relapsed or refractory AML. While it is not yet FDA-approved, it may be available through clinical trials.

If your leukemia has a KMT2A rearrangement or NPM1 mutation, ask your oncologist whether you might be eligible for a Ziftomenib clinical trial. You can search for open trials at clinicaltrials.gov.

2. Bleximenib (JNJ-75276617, Investigational)

Bleximenib is a menin inhibitor developed by Johnson & Johnson that is being evaluated in clinical trials for acute leukemia with KMT2A rearrangements. Like Ziftomenib, it is not yet FDA-approved but may be accessible through clinical trial enrollment.

3. Enzomenib (DSP-5336, Investigational)

Enzomenib is another menin inhibitor in clinical development. It is being studied both as a monotherapy and in combination with other treatments for acute leukemia. Early data is promising, and it represents another potential option through clinical trials.

4. Standard Chemotherapy Regimens

For patients with relapsed or refractory acute leukemia who cannot access menin inhibitors, standard chemotherapy options remain available. These may include:

• High-dose Cytarabine-based regimens
• FLAG-IDA (Fludarabine, Cytarabine, Idarubicin, and G-CSF)
• Hypomethylating agents (Azacitidine or Decitabine) with or without Venetoclax

These treatments have been used for decades in acute leukemia and remain the backbone of therapy for many patients. However, they work differently than menin inhibitors and may not be as targeted for KMT2A-rearranged or NPM1-mutated disease.

5. Hematopoietic Stem Cell Transplant (HSCT)

For eligible patients, a stem cell transplant may be an option — and in fact, Revumenib is sometimes used as a bridge to transplant. If you achieve remission with any treatment, your oncologist may recommend transplant as a potentially curative approach.

How to Discuss Alternatives With Your Doctor

When talking to your oncologist about alternatives to Revumenib, consider asking:

• "Are there clinical trials for other menin inhibitors that I might qualify for?"
• "What standard chemotherapy options would work best for my specific type of leukemia?"
• "If we can't get Revumenib right away, is there a bridge therapy we can use in the meantime?"
• "Am I a candidate for a stem cell transplant?"

Your oncologist knows your medical history, genetic test results, and overall health — they're in the best position to recommend the right alternative for you.

Before Giving Up on Revumenib

Before switching to an alternative, make sure you've exhausted all options for getting Revumenib:

• Contact SyndAccess at 1-888-567-7963 for help with insurance, pharmacy access, and financial assistance
• Use Medfinder to search for specialty pharmacies that may have it in stock
• Ask your oncologist's office to appeal any insurance denials
• Explore the Revuforj Copay Program, where eligible commercially insured patients may pay as little as $0

For more on finding Revumenib, see our guide: How to find Revumenib in stock near you.

Final Thoughts

Revumenib is a breakthrough treatment, but it's not the only option for patients with relapsed or refractory acute leukemia. If you're facing access barriers, there are other paths forward — from clinical trials of next-generation menin inhibitors to established chemotherapy regimens and stem cell transplant.

The most important thing is to keep communicating with your oncology team. They can help you find the best treatment for your specific situation, whether that's Revumenib or an alternative approach.

Learn more about Revumenib in our other articles:

• What is Revumenib? Uses, dosage, and what you need to know
• Revumenib drug interactions: What to avoid
• How to save money on Revumenib in 2026