What Management Said
Read the full Q1 2026 transcript ↗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.
What went well
- MRD revenue grew 53% year-over-year to $67.1 million on broad-based strength across both clinical and pharma, driving total revenue up 45% to $70.9 million, with MRD accounting for roughly 95% of the total.
- clonoSEQ clinical volumes rose 41% year-over-year to a record of nearly 32,600 tests, up 9% sequentially, with growth in every reimbursed indication led by DLBCL at over 19% growth versus the prior quarter.
- Adaptive raised full-year MRD revenue guidance to $260 million-$270 million (from $255 million-$265 million) and lifted its clinical volume growth outlook to at least 35% (from over 30%), citing stronger-than-expected Q1 performance and continued momentum.
- The company recognized its first-ever U.S. primary endpoint milestone ($9 million, tied to MRD as a primary endpoint in the CEPHEUS multiple myeloma trial) while pharma backlog grew 24% year-over-year to approximately $254 million and 10 registrational studies were signed in Q1 alone, already exceeding the full-year goal.
- Sequencing gross margin expanded 8 percentage points year-over-year to 70%, driven by NovaSeq-related assay-cost efficiencies, overhead leverage on higher volumes, and favorable pricing across clinical and pharma.
- Financial discipline improved: MRD segment adjusted EBITDA reached $12.1 million versus a $4.1 million loss a year ago, cash burn was reduced, and the company ended the quarter with approximately $222 million in cash.
- Key adoption drivers all advanced: community volumes grew 67% year-over-year to 35% of testing, blood-based testing reached 49% of MRD volume, ordering clinicians grew 43% to nearly 5,000, U.S. ASP rose 11% to $1,360 per test, and clonoSEQ was added to the Texas Medicaid policy manual.
What went wrong
- The company remained unprofitable at the consolidated level, posting a net loss of $20 million (including ~$2.9 million of OrbiMed royalty-financing interest expense) and a total-company adjusted EBITDA loss of $2.5 million.
- Immune Medicine revenue fell 26% year-over-year to $3.8 million on timing of sample receipts and processing, and the Immune Medicine segment posted a $10.4 million adjusted EBITDA loss.
- Pharma revenue growth of 53% was flattered by the milestone; excluding milestones it grew 33%, and management stated it does not anticipate any additional milestone revenue for the remainder of the year.
- MRD segment adjusted EBITDA stepped up only about $2 million sequentially despite the $9 million pharma milestone, reflecting Q1 seasonal cost increases plus higher personnel, EMR-integration, and reimbursement spend.
- Reimbursement remained an overhang, with analysts pressing on CMS, the CRUSH initiative, PAMA, MolDX nationalization, and prior authorization; management defended clonoSEQ's durability but acknowledged the high-importance risk.
- Total operating expenses (inclusive of cost of revenue) rose 10% year-over-year to $90.1 million on continued commercial-infrastructure and personnel investment.
- Management stayed deliberately conservative on pharma, holding the pharma growth assumption at roughly 11%-12% year-over-year and declining to bake incremental Q1 bookings conversion into the guide despite acknowledged upside.
Guidance Changes
| 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 |
Performance Breakdown
| 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. |
Earnings Call Themes & Trends
| 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. | — |
Q&A Summary
Andrew Brackmann (William Blair) asked how conversations with community accounts have evolved over the past year given the company is already at its full-year community-mix target.
Susan Bobulsky said conversations have shifted from 'what is MRD and why should I care' a year ago to practical implementation today, with established testing protocols in a number of large community centers and networks aimed at standardizing testing so all heme patients have access, a positive sign that MRD is becoming entrenched as standard of care in the community.
Andrew Brackmann (William Blair) followed up on how clonoSEQ is positioned on reimbursement amid CMS/CRUSH noise and whether its rate is durable against MolDX nationalization or prior authorization.
Chad Robins said after internal and external evaluation with outside counsel, Adaptive determined it is not currently subject to PAMA reporting this cycle because clonoSEQ's episode billing structure is not on the CLFS list and its PLA-coded recurrence-monitoring revenue is well below the 50% Medicare threshold; the company is also pursuing a multi-pronged durability strategy including productive MolDX discussions to increase tests per bundle.
David Westenberg (Piper Sandler) asked how to think about MRD as a primary endpoint driving companion-diagnostic/on-label dynamics and pharma pull, plus any reimbursement or strategic monetization from matching recurring clinical patients into trials.
Susan Bobulsky said increasing use in regulated and interventional studies is highly favorable given Adaptive is the only FDA-cleared assay with deep sensitivity and high specificity; the FDA has not required MRD to be a companion diagnostic, but pharma partners are actively seeking to partner to maximize MRD uptake and community adoption; clinical-trial matching is a potential future application still under early exploration.
David Westenberg (Piper Sandler) asked whether DLBCL's 19% quarter-over-quarter growth benefited from ASH presentations and whether it is sustainable beyond a few quarters.
Susan Bobulsky attributed the strength to sustainable moats (brand awareness as a heme MRD test, technology advantages, broad real-world experience, coverage, and customer satisfaction) rather than a one-off, noting Adaptive is disproportionately benefiting as market leader; Chad Robins added it is early days for MRD in DLBCL with durable multi-quarter growth ahead, and Bobulsky flagged more significant data expected at ASH.
Mark Massaro (BTIG) asked about the pharma backlog, the primary-versus-secondary funnel, and the economics of a primary endpoint milestone versus a secondary one.
Susan Bobulsky said there are about 190 active studies, 111 of which are primary or secondary endpoint studies (23 primary, 88 secondary); Kyle Piskel said economics vary deal by deal but primary-endpoint milestones are generally somewhat higher than the historically dominant secondary-endpoint milestones.
Mark Massaro (BTIG) asked what inning the company is in on EHR integration and how much upside remains to full maturity.
Chad Robins said the priority is the largest accounts (now seven of the top 10 academic accounts, ~150 community EMR integrations, with Flatiron enabling many accounts to turn on at once) and that the real work is optimizing pull-through post-integration; early results are strong where the playbook has been applied, but it remains early overall.
Subbu Nambi (Guggenheim Partners) asked for the latest on discussions to increase the Medicare bundle beyond four tests and whether it is a late-2026 or 2027 opportunity.
Chad Robins declined to predict timing of government contractors and agencies but said Adaptive has a very strong relationship with MolDX, continues to develop strong evidence, and has had very productive discussions.
Subbu Nambi (Guggenheim Partners) asked about progress transitioning pharma from milestone payments toward a more direct pay-for-service structure and how partners are receiving it.
Susan Bobulsky said it is a long, multi-year process since many contracts are multi-year and renegotiations arise only as contracts expire; where it has come up it has been a topic of conversation every time, and many of those discussions remain ongoing.
Subbu Nambi (Guggenheim Partners) asked Kyle about the sequencing gross-margin ceiling this year, the quarterly progression, and whether the full NovaSeq benefit lands in 2026.
Kyle Piskel reiterated ~75% as the North Star, describing a fair, roughly linear step-up toward 75% through the year as increasing NovaSeq X volume compounds value and improving price points add further margin.
Sebastian Sandler (JPMorgan) asked about pharma MRD bookings conversion, whether incremental Q1 bookings convert to revenue in-year given a typical ~20% in-year release rate, and potential upside to the guide.
Kyle Piskel said it was a great start but pharma is lumpy quarter-to-quarter, so the guide prudently holds pharma growth at roughly 11%-12% year-over-year; if the booking pace and backlog pull-through continue, it could provide an opportunity to lift the guide in the back half or even next quarter.
Sebastian Sandler (JPMorgan) followed up on why MRD adjusted EBITDA stepped up only ~$2 million sequentially despite the $9 million pharma milestone and asked about incremental MRD EBITDA margins and pacing.
Kyle Piskel cited Q1 seasonality with some non-recurring increased costs and lower Q1 pharma revenue versus Q4; he declined to give a firm MRD EBITDA margin but said the base business will keep growing sequentially each quarter.
Dan Brennan (TD Cowen) asked what the puts and takes would be if volume comes in above the raised 35% growth guide over the back half.
Susan Bobulsky expressed high confidence in at least 35% with real upside potential, driven by EMR integrations and serial-testing pull-through (especially Flatiron), rising blood-based testing (29% of myeloma MRDs), and sustained disproportionate community growth supported by favorable guidelines and standardized protocols, while staying attentive to emerging competition.
Dan Brennan (TD Cowen) asked about the commercial organization plan, headcount targets, and balancing profitability with enough sales coverage against competition.
Susan Bobulsky said the current 65-rep field team (split evenly between academic account managers and community-focused diagnostic hematology specialists) is the right team with manageable workloads, and no significant expansion is expected this calendar year; Kyle Piskel added continued capital deployment behind EMR integrations, reimbursement/revenue-cycle management, and clinical-utility data generation.
John Wilkin (Craig-Hallum) asked what is driving the acceleration in the pharma sequencing business (historically a high-single-digit grower, now over 30% after ~24% in Q4) and whether it is sustainable.
Kyle Piskel credited strong bookings and backlog plus increasing pull-through as more pharma partners generate data and get trial readouts; he expects it to grow through the year but held the guide given quarter-to-quarter lumpiness.
More on Adaptive Biotechnologies Corp
Reported 2026-05-05 · figures from the Adaptive Biotechnologies Corp Q1 2026 earnings call.
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