What Management Said

Read the full Q4 2025 transcript ↗

I would like to welcome you to Adaptive Biotechnologies Fourth Quarter and Full Year 2025 Earnings Conference Call. Earlier today, we issued a press release reporting Adaptive financial results for the fourth quarter and full year of 2025. In addition, non-GAAP financial measures will be discussed during the call, and a reconciliation from non-GAAP to GAAP metrics can be found in our earnings release. As shown on Slide 3, in the MRD business, full-year revenue grew 46% year-over-year, and we achieved profitability ahead of expectations.

We also delivered several key catalysts in the year that positioned the business for sustained growth and continued margin expansion. clonoSEQ clinical testing revenue grew 64% for full year 2025 and 59% in the fourth quarter compared to the prior year. As shown in the chart, volumes increased sequentially throughout the year, reaching a new record of 30,038 tests in the fourth quarter, up 43% year-over-year and 11% sequentially. Growth was broad-based across all reimbursed indications, with DLBCL, MCL, and multiple myeloma driving the majority of year-over-year growth.

Volume growth throughout the year was driven by a combination of interrelated factors, including blood-based testing, community presence, EMR integrations, clinical guideline inclusion, and ongoing data generation. In multiple myeloma, blood-based testing reached 27%, which is a 6-point increase year-over-year, which is particularly meaningful given the bone marrow-based nature of the disease. Taken together, these drivers continued to increase both physician adoption and testing frequency per patient across indications. Turning to Slide 6, in addition to volume, clinical revenue growth was also driven by continued ASP expansion.

What went well
  • The MRD business achieved full-year profitability ahead of expectations, with MRD revenue up 46% year-over-year and MRD adjusted EBITDA turning positive at $15.2 million in 2025 versus a $41.2 million loss in 2024.
  • clonoSEQ clinical testing set a new record of 30,038 tests in Q4 (up 43% year-over-year and 11% sequentially), and clinical testing revenue grew 64% for the full year and 59% in Q4, with growth broad-based across all reimbursed indications.
  • Total company revenue grew 55% for the full year to $277 million while cash burn fell 68%, driving full-year adjusted EBITDA to positive $12.2 million (versus an $80.4 million loss in 2024) and ending the year with a strong $227 million cash position.
  • Sequencing gross margin expanded sharply to 71% in Q4 (up 12 points year-over-year, 5 points sequentially) and 66% for the full year (up from 53% in 2024), driven by production efficiencies, labor leverage, and the NovaSeq X Plus transition.
  • Average U.S. ASP reached $1,307 for the year (up 17%) and exited Q4 at about $1,350, supported by renegotiating eight major payer contracts (Humana, Aetna, Horizon, multiple Blue Cross plans) and signing new agreements with Anthem, Centene, Florida, and L.A. Care.
  • The Immune Medicine business began monetizing its data with two distinct Pfizer licensing deals (a data licensing agreement plus an RA target-discovery collaboration), lifting Q4 IM revenue to $9.8 million from $3.8 million a year earlier.
  • Commercial execution deepened, with 173 integrated EMR accounts now driving ~40% of ordering volume, ordering HCPs up 45% year-over-year, community testing up 18% sequentially, and over 90 abstracts presented at ASH reinforcing MRD's interventional role.
What went wrong
  • The Genentech collaboration was terminated in August 2025 and all remaining amortization was accelerated into Q3, leaving no ongoing Genentech collaboration economics in results after the third quarter.
  • Management made the strategic decision to halt further investment in its lead TCR-depleting antibody program in ankylosing spondylitis despite completing a preclinical data package, redirecting capital away from therapeutic development toward data generation and AI modeling.
  • Weather-related disruptions in early Q1 2026 (FedEx delivery interruptions, hospital and practice closures) affected the timing of sample arrival and, to some degree, volume, creating a near-term headwind heading into the new year.
  • Net loss remained sizeable at $13.6 million for Q4 and $59.5 million for the full year, and the company still carries OrbiMed royalty-financing interest expense of $11.8 million for 2025.
  • The 2026 clonoSEQ volume guide of more than 30% growth marks a deceleration from the 43% Q4 growth rate as the business laps a much larger base, and management framed both the volume and ASP guidance as deliberately prudent early in the year.
  • The 2026 ASP target of ~$1,400 depends partly on closing two large national payer contracts that move roughly 17%-18% of volume, carrying execution and timing risk that skews the ASP benefit toward the second half.
  • Q1 is expected to be the highest quarterly cash-utilization period of the year, primarily due to annual corporate bonus payments.

Guidance Changes

MetricPeriodCurrent guidance
MRD revenueFY2026$255M-$265M (implies ~22% YoY growth, or ~30% excluding milestones); ~45% first half / 55% second half weighted
MRD milestone revenueFY2026$8M-$9M based on current line of sight
clonoSEQ test volume growthFY2026More than 30% year-over-year growth
Average U.S. ASP per testFY2026~$1,400 per test (roughly linear through the year, more of a second-half dynamic)
Blood-based testing mixFY2026Expected to exceed 50% of total MRD volume
Community testing mixFY2026More than 35% of testing to originate in the community
Total operating expenses (incl. cost of revenue)FY2026$350M-$360M (~6% YoY growth at midpoint)
Adjusted EBITDA & free cash flow (whole company)FY2026Positive adjusted EBITDA and positive free cash flow for the whole company by year-end (exit Q4 2026)

Performance Breakdown

MetricYoYNote
Total company revenue (reported) +51% Q4 / +55% FY Q4 revenue of $71.7 million and full-year revenue of $277 million driven by strong MRD execution and the ramp of Immune Medicine data licensing.
MRD revenue (ex-Genentech) +54% Q4 / +46% FY Q4 MRD revenue of $61.9 million (67% clinical, 33% pharma); full-year MRD ~$212 million including $19.5 million of milestone revenue (up 45% excluding milestones).
clonoSEQ clinical testing revenue +59% Q4 / +64% FY Record test volumes plus ASP expansion; growth broad-based across all reimbursed indications with DLBCL, MCL, and multiple myeloma driving the majority of year-over-year growth.
clonoSEQ test volume +43% (30,038 vs 20,945) New quarterly record, up 11% sequentially, driven by blood-based testing, community presence, EMR integrations, guideline inclusion, and data generation; multiple myeloma was 44% of U.S. volume.
MRD pharma revenue +20% FY (+11% ex-milestones) Included $19.5 million of regulatory milestone revenue; ended the year with ~$210 million backlog; CLL and ALL bookings more than tripled and ~60% of the portfolio now includes MRD as an endpoint (up from ~40% in 2024).
Immune Medicine revenue +158% Q4 ($9.8M vs $3.8M) / +17% FY Full-year IM revenue of $23.4 million, with the Q4 step-up driven primarily by the Pfizer data licensing agreement.
Sequencing gross margin +12 pts to 71% Q4 / +13 pts to 66% FY Lower cost per sample from production efficiencies, labor leverage, and the transition to NovaSeq X Plus.
Average U.S. ASP per test +17% to $1,307 Renegotiation of eight major payer contracts, new payer agreements, the Medicare Gapfill rate at the start of 2025, expanded DLBCL/CLL coverage, and revenue-cycle-management improvements that lifted commercial cash collections 74%.
Adjusted EBITDA (whole company) $4.1M Q4 (vs -$16.4M) / $12.2M FY (vs -$80.4M) Strong top-line growth, improving sequencing efficiency, and disciplined spending; MRD adjusted EBITDA reached +$15.2 million while the IM loss narrowed to $31 million.
Total operating expenses (incl. cost of revenue) +4% Q4 / -2% FY Higher MRD sales and marketing investment (EMR and market access) partly offset by lower Immune Medicine R&D; full-year opex of $334.1 million.
Net loss / cash position Net loss $59.5M FY; cash $227M Cash burn fell 68% year-over-year, leaving $227 million in cash, cash equivalents, and marketable securities at year-end (excluding $13.1 million held by Digital Biotechnologies).

Earnings Call Themes & Trends

TopicPrevious mentionCurrent periodTrend
MRD growth playbook (five drivers)Individual drivers building through 2025Management reinvesting in the same five interrelated 2025 growth drivers for 2026 - blood-based testing, community penetration, data readouts, guidelines, and EMR integrations - which it credits for durable, compounding volume growth.—
Blood-based testing adoption41% of clonoSEQ tests a year ago; 27% in myelomaReached 47% of Q4 tests (27% in myeloma, +6 points YoY); expected to exceed 50% of total MRD volume in 2026, meaningful given myeloma's bone-marrow-based biology and 100x lower blood disease burden.—
Community expansion & EMR integrationBuilding community presence and Epic integrationsCommunity testing ~33% of Q4 volume (targeting >35% in 2026); 173 integrated accounts driving ~40% of orders (adding ~40 more in 2026); Flatiron/OncoEMR integration enabling serial testing with ~60% of scheduled serial tests showing up.—
Reimbursement & ASP expansion$1,307 FY2025 ASP, up 17%Targeting ~$1,400 per test in 2026 (long-term $1,700-$1,800 by 2029), anchored by two additional large national payer contracts (~17%-18% of volume), expanded commercial coverage in DLBCL/CLL, and first Medicare recurrence-monitoring coverage in MCL.—
MRD pharma & regulatory tailwindsMRD as endpoint in ~40% of portfolio (2024)~60% of the portfolio now includes MRD as an endpoint, supported by the ODAC recommendation and FDA draft guidance backing MRD as a primary endpoint for multiple myeloma accelerated approvals; registrational trials carry higher value and a halo effect on the clinical business.—
Immune Medicine as a data & informatics platformTherapy-development-oriented; scaling TCR dataRepositioned as a data/informatics business - >5 million paired TCRs across >20,000 antigens and ~50 HLA types - monetized via two Pfizer deals (data licensing + RA target discovery), with the antibody program halted and net burn held to $15M-$20M in 2026.—
Margin expansion & path to profitabilityMRD reached profitability in 2025NovaSeq X Plus (transitioned in the back half of 2025) plus ASP growth and operating leverage support sequencing gross margin walking from ~70% toward 75%, targeting whole-company positive adjusted EBITDA and free cash flow by the end of 2026.—

Q&A Summary

David Westenberg (Piper Sandler) asked how to think about the sequential step-up in clonoSEQ volume, whether there is seasonality, the impact of recent weather in Q1, and whether a higher base makes sequential percentage growth harder.
Susan Bobulsky said Q4 addressed prior deceleration concerns and reflects the long-term opportunity; Q1 is typically strong though lighter due to holidays and weather. Recent weather (FedEx not delivering, hospital and practice closures) mainly affected sample-arrival timing rather than volume, but samples are now flowing back strongly; she remained confident in another strong sequential growth quarter in Q1 and in the full-year guide.
David Westenberg (Piper Sandler) asked how Adaptive parlays its multiple myeloma lead into DLBCL, where penetration is lower and competition is emerging.
Bobulsky said the DLBCL playbook mirrors myeloma - convincing an underdeveloped market that MRD has value. Q4 DLBCL grew 14% sequentially and 115% year-over-year but is still only ~3% penetrated. Drivers include the enhanced ctDNA assay, advancing guidelines, broadening commercial coverage, deeper pharma penetration, and emphasizing the assay's sensitivity and specificity, plus reimbursement and hematologist-relationship head starts as competitors enter.
Subbu Nambi (Guggenheim) asked for thoughts on a competitor's (Quest) newly launched flow cytometry MRD assay for myeloma on sensitivity and pricing.
Bobulsky said flow-based methods are inherently less sensitive than clonoSEQ; Quest's stated 5x10^-6 sensitivity (1 in 200,000 with 10 mL blood) is 5-7x less sensitive than clonoSEQ's routine 1 in 1 million with 2 mL (FDA label ~1 in 1.5 million). Myeloma is trending toward requiring more sensitivity, and blood disease burden is ~100x lower than marrow; with 60%+ of community myeloma testing done in blood, broad reimbursement, and EMR integration, she saw flow only as a backup for the small subset lacking a diagnostic marrow sample.
Subbu Nambi (Guggenheim) asked Kyle Piskel how to pace ASP through the year given private payers are in advanced negotiation.
Piskel said it is best modeled as linear growth; there are specific timing items to lock down on key payer contracts they are focused on converting, but given where they are in the year, linear is the right assumption.
Dan Brennan (TD Cowen) asked for detail on the 2026 EBITDA-positive guide (timing, full-year vs exit, MRD vs immune medicine split) and whether any sales-force expansion is implied.
Piskel clarified the guide is a whole-company exit on Q4 2026; MRD is already adjusted-EBITDA positive and expected to keep growing. Bobulsky said there are ~65 reps in the field split 50/50 academic/community, that this is the right number for now given manageable territories, and that no significant sales-team expansion is planned this year, though opportunistic additions remain possible.
Dan Brennan (TD Cowen) asked why the 2026 guide bakes in only modest further increases for blood-based and community testing after both ramped in Q4.
Bobulsky said they are not capping out but are being prudent based on historical pace; blood was 47% overall (27% in myeloma) with myeloma a big opportunity, and disproportionate DLBCL/MCL growth would further lift blood mix - she was confident of exceeding 50% in 2026. Community was 33% in Q4 (targeting >35%), a disproportionate investment area supported by datasets like MIDAS, guidelines, large community-practice pathways, and Flatiron-enabled serial testing, all offering potential upside.
Mark Massaro (BTIG) asked about the path for sequencing gross margin (66% in 2025 toward over 70% in 2026) and whether margins could go meaningfully above 70% in the out-years given rising ASPs.
Chad Robins noted they had already raised the target from 70% to 75% at JPMorgan and that margins are not fully loaded because the NovaSeq X Plus transition only occurred in the back half of 2025 (a 5%-8% uplift in the first 12 months, over 10% attributable to the transition as more samples layer onto each run). Combined with ASP growth and lower cost per sample, he expects further upside but will walk margin up sequentially from 70% to 75%, expressing confidence in a durable high-margin profile.
Mark Massaro (BTIG) asked why $1,400 is the right 2026 ASP (only ~7% growth) versus the 17% growth in 2025.
Piskel said 2025 benefited significantly from the Medicare Gapfill rate that took effect at the start of the year, with commercial-side traction from contract renegotiations building. For 2026 he wanted to be prudent, citing two focus areas: renegotiating with two large payers representing ~17%-18% of volume (timing drives variability) and navigating commercial coverage dynamics as DLBCL and MCL grow.
Sebastian Sandler (JPMorgan) asked where the most upside to the clonoSEQ volume guide sits - NeoGenomics contribution, guidelines, or recurrence-monitoring coverage.
Bobulsky pointed to early-stage EMR/Flatiron serial testing (about 60% of serial tests showing up as scheduled), EMR account 'optimization' initiatives with strong early pilot results, continued blood and community contributions, and payer-contract timing on ASP. Robins added that the same five drivers - blood, community, data readouts, guidelines, and EMR integrations - underpin the guide and offer a chance to outperform.
Sebastian Sandler (JPMorgan) asked about execution risk on the two payer contracts underpinning the $1,400 ASP, where ASP could land if they are less favorable, and whether it is a first- or second-half dynamic.
Piskel acknowledged some execution risk but expressed confidence in getting there long-term, prioritizing establishing the right rate; pacing is more of a second-half dynamic given it is January, and if the contracts slip there are other levers to grow ASP. Robins added they are quite confident in the ASP guide with multiple levers, so any single contract will not determine the outcome.
Bill Bonello (Craig-Hallum) asked how Adaptive monetizes and scales its leading immune-receptor database now that Immune Medicine is positioned more as a data/informatics business than a therapeutics developer.
Sharon Benzeno said the two distinct Pfizer data-licensing deals validate the massive differentiated dataset and that Adaptive can 'rinse and repeat' similar or differentiated licensing deals across immunology applications, with more to come as the year progresses. Robins added the Pfizer deals represent two data-deal types - licensing data for pharma AI modeling and using Adaptive's capabilities for target-discovery work - providing multiple monetization avenues.
Bill Bonello (Craig-Hallum) followed up on whether investments are needed to make the data more accessible to pharma clients, and on the timing of when the Immune Medicine business could inflect.
Robins said the necessary investments to generate the robust dataset are captured within the $15M-$20M net burn for the year (revenue from the business acts as a burn offset). On inflection, he said any future higher-risk-adjusted-return investment with a business case would be shared at that time, but the current path forward is framed around that $15M-$20M net burn.

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Q4 2025 call
Reported 2026-02-05 · figures from the Adaptive Biotechnologies Corp Q4 2025 earnings call.

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