I would like to welcome you to Adaptive Biotechnologies first quarter 2026 earnings conference call. 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. MRD revenue grew 53% year-over-year, reflecting broad-based strength across both clinical and pharma. We also delivered meaningful margin expansion, with sequencing gross margin increasing 8 percentage points year-over-year to 70%, driven by scale and operational efficiency.
Given the strength we're seeing in the MRD business, we are raising our full-year MRD revenue guidance to a range of $260 million-$270 million. Our clinical business continues to deliver strong growth, with revenue up 54% year-over-year. ClonoSEQ tests reached another quarterly record of almost 632,600 in Q1, up 9% sequentially. Growth was observed in all reimbursed indications, led by DLBCL at over 19% growth versus prior quarter.
This shift is closely linked to expansion of the community setting, where promotion of favorable guideline updates and implementation of standardized testing protocols contributed to growth rates that outpaced the rest of the business. Community volumes grew 67% year-over-year and now represent 35% of total testing. Growth in the community business was further supported by our EMR-enabled workflows, which are driving UP repeat utilization. Serial monitoring orders available to Flatiron integrated accounts are widely being utilized, and strong initial pull-through rates have further improved with 72% of repeat orders due are being fulfilled.
| Metric | Period | Current guidance |
|---|---|---|
| MRD revenue | FY2026 | $260M-$270M (raised; ~25% YoY growth at midpoint, or ~33% excluding milestones) |
| clonoSEQ clinical test volume growth | FY2026 | At least 35% (raised), with potential for upside |
| U.S. ASP (price per test) | FY2026 | Approximately $1,400 per test (on track), supported by CLL/DLBCL policy expansions, Medicaid traction, and commercial payer negotiations |
| Sequencing gross margin | FY2026 | Over 70%, stepping up roughly linearly toward a ~75% North Star through the year |
| Total operating expense (incl. cost of revenue) | FY2026 | $350M-$360M reiterated (~75% MRD, ~20% Immune Medicine, remainder corporate unallocated) |
| Adjusted EBITDA and free cash flow | FY2026 | On track for positive adjusted EBITDA and positive free cash flow for the full company by the end of 2026 |
| Immune Medicine cash burn | FY2026 | $15M-$20M expected range |
| MRD revenue seasonality / milestone | FY2026 | ~45% first half / 55% second half; includes $9M milestone recognized in Q1, no further milestone revenue anticipated this year |
| Metric | YoY | Note |
|---|---|---|
| Total revenue | +45% to $70.9M | Driven primarily by continued MRD strength, which accounted for approximately 95% of total revenue. |
| MRD revenue | +53% to $67.1M | Broad-based strength across clinical (65% of MRD) and pharma (35% of MRD), including a $9M primary-endpoint milestone. |
| Clinical MRD revenue | +54% | Record clonoSEQ volumes with growth across all reimbursed indications, higher ASP, and community/blood-based expansion. |
| Pharma MRD revenue | +53% (+33% excluding milestones) | First U.S. primary-endpoint milestone plus strong bookings and backlog pull-through across regulated and registrational studies. |
| Immune Medicine revenue | -26% to $3.8M | Primarily timing of sample receipts and processing. |
| clonoSEQ clinical test volume | +41% to a record ~32,600 (+9% QoQ) | Strong continued adoption led by DLBCL (+19% QoQ), community growth, blood-based testing, and EMR-enabled serial monitoring. |
| Community test volume | +67% (now 35% of total testing) | Favorable guideline updates, standardized testing protocols, and EMR-enabled workflows driving repeat utilization. |
| U.S. average selling price (ASP) | +11% to $1,360 per test | Continued pricing gains from policy expansions, Medicaid payment traction, and commercial payer negotiations. |
| Sequencing gross margin | +8 pts to 70% | NovaSeq-driven assay-cost efficiencies, overhead leverage on higher volume, and favorable pricing across clinical and pharma. |
| MRD segment adjusted EBITDA | $12.1M vs. -$4.1M prior year | Revenue growth (including milestone revenue) and continued operating leverage; total-company adjusted EBITDA was a $2.5M loss. |
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| Community-setting expansion | Conversations centered on educating clinicians about what MRD is and why it matters | Conversations have shifted to practical implementation and standardized testing protocols in large community centers; community volumes grew 67% YoY to 35% of testing, already at the full-year target. | — |
| Blood-based MRD testing | Growing share of a historically bone-marrow-driven workflow | Blood-based testing reached 49% of MRD volume overall and 29% in multiple myeloma (up 8 pts YoY), rapidly approaching the goal of over 50% contribution and driving higher testing frequency. | — |
| EMR integration (Epic / Flatiron) | Building out integrations to enable serial-monitoring workflows | Six new Epic accounts added year-to-date (five more live within a month), seven of the top 10 accounts now fully integrated, ~150 community EMR integrations, with a defined pull-through playbook still early in optimization. | — |
| MRD as a drug-development endpoint / biopharma flywheel | MRD used mostly as a secondary endpoint in pharma studies | First U.S. primary-endpoint milestone recognized (CEPHEUS); ~190 active studies (111 primary/secondary, of which 23 primary), 10 registrational studies signed in Q1, and ~20 interventional studies using MRD to guide therapy, reinforcing the clinic-to-pharma flywheel. | — |
| Reimbursement durability | Episode-based MolDX billing with periodic policy expansion | Management determined clonoSEQ is not subject to PAMA reporting this cycle; pursuing a multi-pronged strategy including recurrence monitoring, discussions to increase tests per Medicare bundle beyond four, plus new Texas Medicaid listing (up to six tests/year). | — |
| Immune Medicine platform, AI/ML, and partnerships | Scaling TCR-antigen data sets and modeling | Now over 6 million functional TCR-antigen pairs spanning ~50,000 antigens and 50+ HLA types; digital AI model beat public benchmarks (published); kicked off the Pfizer RA target-discovery partnership (1,000+ samples, data package due H2 2026), operating within a $15M-$20M cash-burn range. | — |
| Competition in DLBCL | New competitors entering MRD in DLBCL | clonoSEQ grew 19% quarter-over-quarter in DLBCL; management attributes durable, multi-quarter growth to brand, sensitivity/specificity, real-world evidence, and market leadership, expecting to disproportionately benefit as category noise mounts, with more data planned at ASH. | — |