A new Next Generation Sequencing (NGS) based OncogenomicDx HEME v 2.0 test for myeloprolifertive or myeloysplastic disorders is being offered by the Molecular Diagnostics and Hematology Laboratories in the Department of Pathology to help in the diagnosis, prognosis and treatment decisions to start tyrosine kinase inhibitors (TKI) regimens. Specifically this test identifies single nucleotide variants, copy number variations or fusions in a total of 162 genes involved in pathways that have been related to evaluate suspected myeloproliferative or myelodysplastic disorders simultaneously. The use of NGS combined with bioinformatic interpretation allows the identification of drug targets in multiple genes simultaneously. The increasing utilization of targeted therapies, such as TKI in clinical practice is adding new dimensions to molecular testing for cancer patients. Combinatorial therapy is rapidly evolving to target multiple points along the involved signaling pathways simultaneously or in sequence, depending on how well genomic alterations in cancers are identified and the dynamic signaling network response to various target gene inhibitors are understood.