What Management Said
Read the full Q3 2025 transcript ↗I would like to welcome you to Adaptive Biotechnologies third-quarter 2025 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. We delivered meaningful wins, sustained growth, and further strengthened our financial position. Also, this quarter, and ahead of plan, the MRD business became cash flow positive, a significant achievement that underscores the strength and scalability of our model.
MRD revenue grew 52% year-over-year, driven by robust increases in clinical volume and ASP. This growth reflects expanding clinical utility and broader integration of MRD testing into patient care. Total company sequencing gross margin improved 10 percentage points year-over-year to 66%. Given this performance, we are again updating our full-year guidance to reflect a higher MRD revenue range, lower operating expenses, and a reduced annual cash burn.
ClonoSEQ clinical revenue had impressive growth of 83% year-over-year and 18% quarter-over-quarter. First, blood-based testing now represents 45% of volume, achieving our full-year goal ahead of plan. Third, NHL testing expanded to 15% of total clonoSEQ volume, led by DLBCL and MCL sequential growth. Fourth, ordering HCPs grew 38% year-over-year to more than 4,100, with sequential growth of 9% in academic centers and 12% in community practices.
What went well
- The MRD business hit major profitability milestones: adjusted EBITDA of $7 million (versus a $6.1 million deficit a year ago) and, ahead of plan, the MRD base business turned cash-flow positive, underscoring the scalability of the model.
- MRD revenue grew 52% year-over-year to $56.8 million (excluding Genentech), with clonoSEQ clinical revenue up an impressive 83% year-over-year and 18% sequentially on broad-based volume gains and higher ASP.
- clonoSEQ delivered over 27,100 tests (up 38% year-over-year, 7% sequentially) across all reimbursed indications, and tested more than 19,400 unique patients, up 41% year-over-year.
- Total company sequencing gross margin improved 10 percentage points year-over-year to 66% (up from 56%), driven by lab operating leverage, stronger pricing, and the NovaSeq X Plus implementation.
- U.S. clonoSEQ ASP rose 28% to over $1,340 per test, keeping the company on track for full-year ASP of $1,300 or higher toward its long-term $1,700-$1,800 target, aided by new payer wins (first commercial DLBCL coverage and two CLL payers, bringing CLL covered lives past 260 million).
- Operating discipline drove cash burn down 51% through the first nine months versus last year, ending the quarter with a strong $217 million cash position, prompting a full-year guidance raise on revenue with lower opex and cash burn.
- EMR integration momentum accelerated with 11 new integrations (six of the top 10 accounts now integrated); nearly 40% of commercial tests came from integrated accounts, and Flatiron integrated accounts grew 17% sequentially.
What went wrong
- The Genentech partnership was concluded following Genentech's internal portfolio prioritization, removing a collaboration and the associated (non-cash) revenue stream, though Adaptive was released from exclusivity and further obligations.
- Immune medicine remained a drag, posting an adjusted EBITDA deficit of $10 million (excluding Genentech) versus $8.7 million a year ago, with pharma and academic services revenue falling to $3.4 million from $5.5 million a year ago.
- Excluding the non-cash Genentech revenue, the total company still ran an adjusted EBITDA loss of $5.8 million and a net loss of $24.2 million for the quarter.
- Emerging competition is entering diffuse large B-cell lymphoma (DLBCL), with more competitors expected in the coming year, requiring Adaptive to defend its lead in a newly contested indication.
- Recent FDA/agency uncertainty around surrogate endpoints introduced risk to MRD's path to broader acceptance as an accelerated-approval endpoint beyond multiple myeloma.
- Q4 guidance implies a sequential deceleration: management flagged holiday-driven seasonality weighing on Q4 volume and ordering, tempering the recent double-digit sequential growth trend.
- New payer coverage wins in DLBCL and CLL will not be reflected in the quarter's results, with the ASP benefit only coming over time as contracting moves through implementation.
Guidance Changes
| Metric | Period | Current guidance |
|---|---|---|
| MRD revenue | FY2025 | $202 million-$207 million (raised on stronger Q3 clinical revenue and higher milestone revenue) |
| clonoSEQ test volume | FY2025 | approximately 104,000 tests, exceeding the prior 35% growth target |
| MRD milestone revenue | FY2025 | $18 million-$19 million |
| Total MRD revenue growth (YoY) | FY2025 | 39%-42% total; 38%-42% for the MRD-based business excluding milestones at the midpoint |
| Total company operating expense (incl. cost of revenue) | FY2025 | $335 million-$340 million (tightened and top end lowered) |
| Total company cash burn | FY2025 | $45 million-$50 million (narrowed and lowered, driven by higher MRD revenue) |
| Full-year clonoSEQ ASP | FY2025 | $1,300 or higher |
| Immune medicine cash burn | FY2025 | $25 million-$30 million (reaffirmed) |
Performance Breakdown
| Metric | YoY | Note |
|---|---|---|
| Total company revenue | +102% to $94 million | Includes $33.7 million of non-cash revenue from the remaining amortization of prior Genentech payments; underlying growth driven by the scaling MRD business. |
| MRD revenue (excl. Genentech) | +52% to $56.8 million | Robust increases in clinical volume and ASP plus milestone revenue; clinical and pharma contributed 67% and 33% respectively. |
| clonoSEQ clinical revenue | +83% (+18% sequentially) | Broad-based volume expansion across all reimbursed indications combined with continued ASP improvement. |
| clonoSEQ test volume | +38% to 27,111 tests | Volume growth across all reimbursed indications; 45% blood-based, 31% community, 15% NHL, with ordering HCPs up 38% to more than 4,100. |
| U.S. clonoSEQ ASP | +28% to over $1,340 per test | Continued strength in cash collections and improved pricing through various contracting initiatives, including the implemented Anthem win. |
| MRD pharma revenue | +11% | Solid partner demand, inclusive of $6.5 million in milestone revenue; backlog ended above $200 million with 2025 CLL bookings more than double last year. |
| Sequencing gross margin | +10 pts to 66% | Lab operating leverage on higher volumes, stronger pricing across clinical and pharma, and NovaSeq X Plus efficiency gains (NovaSeq X contributed ~2 pts of the MRD improvement in just two months). |
| MRD adjusted EBITDA | +$7 million (from a $6.1 million deficit) | Revenue scale and margin expansion drove the MRD base business to positive adjusted EBITDA and cash-flow positivity ahead of plan. |
| Total operating expenses (incl. cost of revenue) | +6% to $83.7 million (flat sequentially) | Higher SG&A for EMR and reimbursement efforts and higher cost of revenue from volume growth, partially offset by lower R&D expense. |
| Total company adjusted EBITDA (excl. Genentech) | -$5.8 million loss (from a $17.8 million loss) | Sharply narrower loss as the profitable MRD segment offset the immune medicine deficit of $10 million; cash position ended at $217 million. |
| Immune medicine services revenue | -$2.1 million to $3.4 million (from $5.5 million) | Lower pharma and academic services revenue as the immune medicine segment stays in R&D-investment mode. |
Earnings Call Themes & Trends
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| MRD as a profitable, scaling growth engine | MRD scaling toward profitability | MRD is now a profitable scaling business: adjusted EBITDA of $7 million and cash-flow positive ahead of plan, delivering consistent growth and margin expansion with multiple levers still to increase penetration. | — |
| EMR integration & serial testing | Building EMR integrations for volume growth | 11 new integrations completed (six of top 10 accounts integrated); nearly 40% of commercial tests now from integrated accounts, with Flatiron/OncoEMR serial-testing plans (1/3/6/12-month cadences) building a scalable moat and more tests per patient. | — |
| Clinical guidelines & validation | Guideline inclusion expanding across indications | NCCN guidelines updated in CLL this quarter (serial MRD every 3-6 months, NGS as flow alternative), strengthened clonality ID in myeloma, and DLBCL added to NCCN lymphoma guidelines for the first time, reinforcing clonoSEQ adoption. | — |
| Blood-based & indication mix expansion | Growing blood-based share; NHL emerging | Blood-based testing reached 45% of volume (full-year goal hit early); myeloma blood at 24% and ALL at 37%; DLBCL grew to 9% of volume (from 6% a year ago) and NHL reached 15%, diversifying beyond core myeloma/ALL. | — |
| MRD as a regulatory endpoint in pharma | clonoSEQ established endpoint in multiple myeloma (ODAC/CHMP) | Endpoint qualification efforts underway in CLL and DLBCL (2025 CLL bookings more than double last year); 19 ongoing primary-endpoint studies (12 myeloma, 6 leukemia, 1 MCL), with KOLs signaling CLL qualification far faster than myeloma's 10-year path. | — |
| Immune medicine & AI/ML pivot | Genentech and Microsoft collaborations; TCR antigen model | Genentech partnership concluded (released from exclusivity); accelerated data generation and AI/ML modeling now redeployed toward multiple high-value partnership opportunities, plus a selected lead T cell depleting antibody candidate advancing toward IND-enabling studies in autoimmunity. | — |
| Financial discipline & capital position | Reducing cash burn | Cash burn cut 51% over nine months, ending with $217 million in cash; full-year opex and cash burn guidance both lowered, with the MRD business generating positive cash flows while sustaining top-line growth. | — |
Q&A Summary
Mark Massaro (BTIG) asked how to think about the $200 million-plus MRD pharma backlog being released over the coming quarters, noting the business is becoming more recurring and linear.
Susan Bobulsky said the company is pleased with performance and reiterated anticipated revenues for the year; the backlog is generally recognized over a five-to-seven-year time frame and is strong heading into next year, with strong new bookings. She expects continuing growth in a similar range to this year (no formal 2026 guidance yet), supported by ODAC/CHMP decisions in myeloma and momentum in NHL and leukemias, plus MRD's potential role as an endpoint in additional indications.
Mark Massaro (BTIG) followed up on whether a 30% MRD volume growth bar is achievable in 2026, given EMR integrations, blood growth, community penetration, and new-patient testing.
Chad Robins declined to give specific 2026 guidance but said all the underlying factors cited give great confidence in the trajectory of the business in 2026 and beyond, with more specific guidance to come shortly.
Subbu Nambi (Guggenheim) asked how much clonoSEQ ASP can continue to lift into next year, given the $1,800 long-term target and this year's strong progress.
Kyle Piskel declined a firm 2026 number but, with $1,340 in Q3, said he feels confident about the year's exit rate; momentum around coverage in CLL and DLBCL sets a strong foundation for meaningful ASP growth in 2026, reiterating the $1,700-$1,800 long-range target.
Subbu Nambi (Guggenheim) asked whether mature EMR-integrated accounts keep growing strongly and how long before they level off.
Susan Bobulsky said integrations drive growth across accounts of all sizes and also protect existing business from competition; integrated accounts grew 9% quarter-over-quarter versus 6% for non-integrated (a 50% higher growth rate). Most integrations are less than a year old; well-penetrated accounts eventually return to more stable growth but retain benefits like democratized ordering, reduced staff-turnover impact, lower HCP workload, and stronger competitive moats.
Subbu Nambi (Guggenheim) asked what tests truly compete with clonoSEQ given checks suggested little close competition.
Susan Bobulsky said in many indications the competition is lack of testing or traditional (non-MRD) disease-burden methods, plus traditional and next-generation flow used in-house at academic centers, where clonoSEQ data shows a clear advantage (with more data coming at ASH). The one indication with emerging competition is DLBCL, but Adaptive is confident given 7,000-plus DLBCL tests in the past 12 months, 900-plus ordering HCPs, Medicare and expanding commercial coverage, and universal testing across all lymphoid cancers.
Andrew Brackmann (William Blair) asked whether this year's guideline wins are already impacting utilization and how they are changing conversations with physicians.
Chad Robins reviewed the wins (strengthened clonality ID in myeloma, DLBCL added to NCCN lymphoma guidelines for the first time, and CLL serial MRD at 3-6 month frequency with NGS as a flow alternative), noting they are recent and provide a strong data-driven call point. Susan Bobulsky added examples: in myeloma the ID test at diagnosis supports the MIDAS transplant-avoidance message (valuable in the community), and in CLL the guidelines enable specific testing-frequency conversations around limited-duration therapy.
Andrew Brackmann (William Blair) followed up on what EMR tools are used to increase testing frequency and how they drive utilization.
Susan Bobulsky pointed to Epic treatment plans, order sets, and analytics/reporting tools that let clinics build clonoSEQ into workflows at specific time points and pull lists of patients due for testing (e.g., patients within a month of finishing frontline DLBCL induction). She said this shift from maximizing integrations to optimizing them will be a bigger theme in 2026.
Sebastian Sandler (JPMorgan) asked where community penetration stands, whether new HCPs are from new or existing accounts, and whether the sales force will expand.
Susan Bobulsky said community is about 30% of volume but still under-penetrated with a high ceiling; the OncoEMR/Flatiron integration is driving growth (17% quarter-over-quarter in Flatiron accounts). New HCPs are coming from both new and existing accounts, with integration democratizing ordering. The company is comfortable with its 65 reps (about half community-focused) and does not anticipate significant near-term expansion, though it may adjust territories.
Sebastian Sandler (JPMorgan) asked for the drivers of the sequencing gross margin step-up and whether the NovaSeq X benefit was pulled forward into Q3.
Kyle Piskel said sequencing gross margin was 66%, up from 64% in Q2; drilling into MRD alone it was up 3 percentage points, with NovaSeq X contributing 2 points from just two months of use (integrated at the end of July). He reaffirmed the 5-8 percentage-point post-launch guidance and expects a continued step-up as volume grows exiting the year.
William Bonello (Craig-Hallum) asked for detail on the multi-time-point serial-testing order capability: how it works, whether it covers all indications, and the potential lift to tests per patient.
Susan Bobulsky said serial testing is available to Flatiron/OncoEMR integrated accounts via a dropdown selecting a single order or a 1/3/6/12-month cadence, across all indications. It is not yet quantified (only three months in, most selecting 3- or 6-month cadences), but she is confident it will yield incremental test growth and is exploring extending it beyond Flatiron.
William Bonello (Craig-Hallum) clarified whether a selected cadence automatically triggers a test every interval.
Susan Bobulsky explained it creates a placeholder order scheduled in the patient's EMR calendar that prompts staff when due; the clinic staff must still act to complete the blood draw, and these orders are not yet in reported order numbers. Adaptive is putting reminders and field tactics in place to pull them through for more consistent testing over time.
William Bonello (Craig-Hallum) asked where blood-based testing stands today and the outlook going forward.
Susan Bobulsky said blood has reached 45% of all MRD tests (the full-year goal, hit a quarter early), with gains in traditionally marrow-based indications (ALL now 37% blood, multiple myeloma 24%, each up 3-4 points year-over-year) plus growing contribution from primarily blood-based DLBCL, MCL, and CLL, with DLBCL a particular driver.
William Bonello (Craig-Hallum) asked whether the national contract wins (coverage versus rate increases) applied across all modalities and whether the quarter saw any benefit.
Chad Robins distinguished coverage (first commercial DLBCL coverage and two CLL policies, which hit now with impact over time) from rate increases. Kyle Piskel said the contracting wins were in effect in Q3 and some will pull through, with room to go on implementation. Robins cited the Anthem win (contracted roughly two quarters ago, implemented this quarter) as an example of the lag between contracting and the ASP lift.
David Westenberg (Piper Sandler) asked about MRD contribution margin, the pace toward cash-flow breakeven, and balancing investment to press the competitive advantage.
Kyle Piskel said the company can manage and pace growth and is confident the business remains cash-flow positive, but may make additional investments to grow volumes or reimbursement faster. Chad Robins added there is a long way to go on penetration of a large, expanding TAM, and the company will keep investing in blood-based testing (assay improvements and clinical studies) to demonstrate clinical utility across the care continuum.
David Westenberg (Piper Sandler) asked about Q4 MRD seasonality, given the guide implies slower sequential volume/ASP than recent quarters.
Kyle Piskel said seasonality is contemplated in guidance: Q4 is one of the tougher periods given holidays and ordering, which factored into the guide, though the company could beat it. He reiterated strong growth ahead into 2026 with some seasonality embedded.
David Westenberg (Piper Sandler) asked how far away clonoSEQ (or NGS clonality) is from being written in as a primary endpoint outside multiple myeloma (CLL, ALL, MCL, NHL).
Susan Bobulsky said active efforts are underway in CLL (led by KOLs with a broad pharma coalition Adaptive is joining) and DLBCL to establish an ODAC-style accelerated-approval designation; leaders say it will not take the 10 years it took in myeloma because there is now a blueprint, though FDA has evolved and uncertainties remain. Chad Robins added that 2025 CLL MRD pharma bookings are more than twice last year's.
Dan Brennan (TD) asked about the DLBCL mix ticking up and how to think about the 2026 opportunity there.
Susan Bobulsky said DLBCL rose from 6% a year ago to 9% of volume and is poised to overtake CLL as the third-largest indication in the next quarter or two; growth is driven by broad data generation and strong pharma interest in MRD-guided treatment, with several companies advancing or considering MRD-inclusive trials that should expand clinical use cases.
Dan Brennan (TD) asked for an early read on 2026 operating-expense leverage and the key puts and takes, and whether the company has commented publicly on it.
Kyle Piskel said investment areas like EMR will keep growing but no major investments are planned, and he expects meaningful leverage to continue across the business (though plans could change). Chad Robins added continued investment in data generation for clinical-utility studies while still driving leverage. Piskel confirmed the company has not yet commented on 2026 opex leverage relative to consensus.
More on Adaptive Biotechnologies Corp
Reported 2025-11-05 · figures from the Adaptive Biotechnologies Corp Q3 2025 earnings call.
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