Adaptive Biotechnologies (NASDAQ:ADPT) reported first-quarter 2026 results that executives said showed “accelerating momentum” in measurable residual disease (MRD) testing, alongside continued operational efficiency gains and a higher full-year MRD revenue outlook.
MRD growth drives revenue as company raises guidance
Total revenue was $70.9 million, up 45% year over year, according to Chief Financial Officer Kyle Piskel. MRD represented about 95% of revenue, with MRD revenue rising 53% to $67.1 million. Piskel said MRD revenue was split 65% clinical and 35% biopharma. Immune Medicine revenue was $3.8 million, down 26% from the prior year due primarily to the timing of sample receipts and processing.
Clinical adoption trends: community expansion, blood-based testing, and workflows
Robins said MRD clinical revenue increased 54% year over year, and that clonoSEQ clinical volumes grew 41% year over year. He reported clonoSEQ tests reached “another quarterly record of almost 632,600 in Q1,” up 9% sequentially, with growth across reimbursed indications led by DLBCL at “over 19% growth versus prior quarter.”
Robins highlighted several adoption dynamics the company views as durable drivers:
- Blood-based testing: 49% of MRD volume, with multiple myeloma blood-based MRD rising to 29% (up 8 percentage points year over year).
- Community setting growth: Community volumes grew 67% year over year and represented 35% of total testing.
- EMR-enabled workflows and repeat utilization: Robins said serial monitoring orders available to Flatiron-integrated accounts are “widely being utilized,” and that 72% of repeat orders due are being fulfilled.
- Ordering clinician expansion: Ordering clinicians rose 43% year over year to nearly 5,000.
- Pricing: U.S. average selling price increased 11% year over year to $1,360 per test, with the company targeting roughly $1,400 per test in 2026.
Robins also noted clonoSEQ’s inclusion in the Texas Medicaid Policy Manual, stating it is “1 of only 2 specific tests included in the newly developed genetic testing section,” with patients eligible for up to six tests per year.
On the evolution of community adoption, Chief Commercial Officer Susan Bobulsky told analysts conversations have moved from “what is MRD” to “practical implementation,” including the establishment of standardized testing protocols in large community centers and networks.
Biopharma MRD: milestone recognition, bookings, and backlog
In biopharma, Robins said the company delivered “one of the strongest quarters to date” in MRD pharma, with revenue up 53% year over year, or 33% excluding milestones. He said Adaptive recognized its “first milestone in the U.S. tied to MRD as a primary endpoint in the CEPHEUS trial in multiple myeloma.”
Robins said new bookings were strong, lifting backlog to about $254 million, up 24% year over year. He added that bookings came primarily from regulated studies, including several registrational trials using MRD as a primary or co-primary endpoint in multiple myeloma and CLL, and that the company has about 20 ongoing interventional studies using MRD for enrollment, stratification, or to guide therapy decisions.
Bobulsky later provided a breakdown of active study types, saying the company has about 190 active studies, with 111 categorized as primary or secondary endpoint studies; of those, 23 are primary and 88 are secondary. Piskel said primary endpoint milestones are “typically a little bit higher” than the secondary endpoint milestones that have historically represented most of the company’s milestone experience, while noting terms vary by deal.
Asked about accelerating pharma MRD bookings and potential revenue conversion, Piskel said the company was “prudent” in maintaining expectations given pharma lumpiness, but added that continued momentum could create “opportunity to lift the guide in the back half of the year or even potentially next quarter.”
Margins, expenses, and cash: operational leverage remains a focus
Piskel said sequencing gross margin (excluding MRD milestones) was 70% in the quarter, up from 62% a year ago, driven by reduced assay costs from efficiencies tied to the NovaSeq launch in the second half of 2025, overhead leverage as volumes grew, and “favorable pricing trends across both clinical and pharma.” Robins also cited an 8-percentage-point year-over-year increase in sequencing gross margin to 70%.
Total operating expenses, including cost of revenue, were $90.1 million, up 10% year over year, which Piskel attributed mainly to investments in commercial infrastructure such as EMR integrations and reimbursement, as well as higher personnel costs.
Segment results showed MRD adjusted EBITDA of $12.1 million compared with a loss of $4.1 million a year ago, while Immune Medicine adjusted EBITDA was a loss of $10.4 million. At the company level, adjusted EBITDA was a loss of $2.5 million. Net loss was $20 million, including approximately $2.9 million of interest expense related to a royalty financing agreement with OrbiMed. Robins said the company ended the quarter with about $222 million in cash and “reducing cash burn.”
Piskel reiterated full-year operating expense guidance of $350 million to $360 million, with spend allocated approximately 75% to MRD, around 20% to Immune Medicine, and the remainder to corporate. He also said the company remains on track to achieve “positive adjusted EBITDA and positive free cash flow for the full company by the end of 2026.”
Reimbursement and policy: PAMA reporting and episode-based Medicare billing
During Q&A, Robins addressed questions about reimbursement dynamics and the potential impact of CMS initiatives. He said Adaptive determined, after internal and external evaluation with outside counsel, that it is “currently not subject to PAMA reporting requirements for this cycle,” pointing to statutory requirements and explaining that clonoSEQ’s episodic billing structure is not identified by CMS as being on the Clinical Laboratory Fee Schedule list. He added that Medicare revenue under the PLA code used for mantle cell lymphoma recurrence monitoring is considered on the CLFS, but those revenues are “well below the 50% revenue threshold” for the current reporting period.
Robins said the company is pursuing a “multi-pronged strategy” including recurrence monitoring and “productive discussion with MolDX to increase the number of tests per bundle” under the episode structure, while declining to predict timing due to the nature of government agencies and contractors.
Management also discussed ongoing Immune Medicine work, including scaling TCR-antigen datasets and a rheumatoid arthritis target discovery partnership with Pfizer. Robins said the company has received over 1,000 patient samples and is on track to deliver the RA data package in the second half of 2026, while operating within an expected Immune Medicine cash burn range of $15 million to $20 million for the year.
About Adaptive Biotechnologies (NASDAQ:ADPT)
Adaptive Biotechnologies is a clinical-stage biotechnology company that focuses on harnessing the adaptive immune system to transform the diagnosis and treatment of disease. Through proprietary immune receptor sequencing and analysis, the company decodes the genetic information of T-cell and B-cell receptors to identify signatures of immune response. Its core technology platform provides insights into immune-driven conditions, enabling more precise monitoring and targeted therapeutic development.
The company’s flagship product, immunoSEQ, offers high-throughput immune repertoire profiling for researchers and pharmaceutical partners.
