Chronic Myelomonocytic leukemia (CMML) is a rare disease that has an annual incidence rate of 0.83-1 case per 100,000 people and generally impacts the elderly population. Therapeutic options for patients with CMML especially after relapse are limited. We present a case of a 77-year old female who was diagnosed with CMML in June, 2003. Patient underwent induction chemotherapy with Topotecan and Fludarabine but failed to achieve complete remission (CR). In January, 2004 she underwent her first matched related donor hematopoietic bone marrow stem cell transplant (SCT) after conditioning with Fludarabine and Busulfan. Patient relapsed in May 2005 after which she received 5-azacitidine and Cytarabine; while she achieved hematological remission, her bone marrow showed persistent dysplasia. She received her second matched donor related SCT in September 2005 after conditioning with Melphalan and Fludarabine. The post-transplant course was uneventful and monthly 5-azacitidine maintenance therapy was initiated 2 months after transplant. Fourteen years later the patient remains on maintenance 5-azacitidine and continues to be in full remission. Due to the length of her treatment with 5-azacitidine herein we describe the long-term use of 5-azacitidine post-SCT and its impact on CMML patients.