I was on hydroxides for several years but it reached a point where it wasn’t working very well (also had a sore on my ankle that concerned the doctor) so switched to Jakafi. There are several drugs that work for CMML, my doctors tell me. I hope your sister is seeing a hematologist at a teaching hospital. I have been taking Jakafi for several years and my doctors say if it becomes ineffective there are others to try. Second opinions are always a good idea. Travel to another state if you have to.