Adaptive Biotechnologies Q4 Earnings Call Highlights

Key Points

• MRD/clonoSEQ momentum: Adaptive's MRD franchise drove the quarter—46% full-year MRD revenue growth, a record 30,038 clonoSEQ tests in Q4 (+43% YoY), rising ASPs and improved collections—and the MRD business reached earlier-than-expected profitability with positive adjusted EBITDA ($15.2M).
• 2026 financial outlook: Management expects clonoSEQ volumes to grow >30% and an average ASP of ~ $1,400, guides MRD revenue of $255–265M (midpoint ~22% YoY) and aims for company-wide positive adjusted EBITDA and positive free cash flow by end-2026, after ending 2025 with $227M in cash and a 68% reduction in cash burn.
• Immune Medicine progress and focus: Adaptive has a proprietary >5M paired-TCR dataset, signed two licensing deals with Pfizer (data licensing and RA target discovery), is shifting resources toward data/AI modeling, and plans to cut Immune Medicine net burn to $15–20M in 2026.

Adaptive Biotechnologies NASDAQ: ADPT executives said the company delivered “remarkable” performance in 2025, driven by sharp growth and improving profitability in its minimal residual disease (MRD) franchise and early monetization steps in its Immune Medicine (IM) data platform.

On the company’s fourth-quarter and full-year earnings call, management highlighted 46% full-year MRD revenue growth and an earlier-than-expected move to profitability in the MRD business. The company also pointed to a 68% reduction in cash burn and ended the year with $227 million in cash, cash equivalents, and marketable securities.

MRD growth led by clonoSEQ volume and expanding reimbursement

CEO Chad Robins said clonoSEQ clinical testing revenue grew 64% for full-year 2025 and 59% in the fourth quarter versus the prior year. clonoSEQ test volume reached a quarterly record of 30,038 tests in Q4, up 43% year-over-year and 11% sequentially, with management describing growth as broad-based across reimbursed indications.

In the U.S., multiple myeloma represented 44% of clonoSEQ volume in 2025, followed by acute lymphoblastic leukemia (ALL) at 30%. Chronic lymphocytic leukemia (CLL) and diffuse large B-cell lymphoma (DLBCL) each accounted for 9%, and mantle cell lymphoma (MCL) represented 5%.

Management attributed volume growth to several factors, including a shift toward blood-based testing, deeper presence in community settings, and continued electronic medical record (EMR) integration work. In Q4, blood-based testing represented 47% of clonoSEQ tests, up from 41% a year earlier. In multiple myeloma, blood-based testing reached 27%, which executives described as notable given the disease’s historical reliance on bone marrow sampling.

Community testing also increased, with volumes up 18% sequentially in Q4 and representing about 33% of total tests. The company said it completed Epic integrations in eight accounts during the quarter, bringing the total to 173 integrated accounts, which now drive approximately 40% of ordering volume. Ordering healthcare providers increased 9% sequentially and 45% year-over-year in Q4, with particularly strong adoption in community settings, according to management.

Pricing and collections were another driver. Adaptive said average selling price (ASP) in the U.S. ended 2025 at $1,307 per test, up 17% year-over-year, and exited the fourth quarter at about $1,350 per test. Executives credited renegotiated payer contracts and new agreements, alongside revenue cycle management improvements supported by AI-enabled workflows. The company said commercial payer cash collections improved 74% year-over-year.

MRD pharma business shifts toward registrational and endpoint-driven trials

Adaptive said MRD pharma revenue grew 20% year-over-year in 2025, including $19.5 million in regulatory milestone revenue. Excluding milestones, pharma revenue grew 11%, and the company ended the year with approximately $210 million in backlog.

Robins said multiple myeloma remained the largest driver of the pharma portfolio, accounting for roughly 70% of sequencing revenue and around 60% of backlog. He also noted that CLL and ALL bookings more than tripled in 2025, which management attributed to emerging data supporting higher-sensitivity MRD and updated clinical guidelines for fixed-duration regimens in CLL.

The company emphasized that MRD is increasingly being embedded into regulated interventional trials. Management said approximately 60% of its pharma portfolio now includes MRD as an endpoint, up from about 40% in 2024, and referenced regulatory momentum such as an ODAC recommendation and FDA draft guidance supporting MRD as a primary endpoint in multiple myeloma accelerated approvals.

2026 outlook: volume growth, higher ASPs, and margin expansion

For 2026, Adaptive said it expects clonoSEQ volumes to grow more than 30% year-over-year. Management’s priorities include expanding blood-based testing to above 50% of total MRD volume, increasing the share of community testing to more than 35%, and adding approximately 40 additional EMR integrations, focused on high- to mid-volume accounts.

On pricing, the company said it is targeting an average ASP of approximately $1,400 per test in 2026, supported by ongoing reimbursement initiatives and two additional large national payer contracts the company anticipates closing. In Q&A, management suggested investors model ASP expansion as “linear growth,” while acknowledging that some contract timing could skew impact toward the second half of the year.

For the MRD business overall, CFO Kyle Piskel guided to 2026 revenue of $255 million to $265 million, including $8 million to $9 million in milestone revenue. At the midpoint, the company said this implies 22% year-over-year growth, or 30% growth excluding milestones. Adaptive also forecast that MRD revenue will be about 45% weighted to the first half and 55% to the second half of 2026.

On profitability, Piskel said Adaptive expects to achieve positive adjusted EBITDA and positive free cash flow for the whole company by the end of 2026, characterizing the adjusted EBITDA target as an “exit on Q4 for the entire company.” He also noted that Q1 is typically the highest quarterly cash utilization due to annual corporate bonus payments.

Immune Medicine: Pfizer licensing deals and a sharper strategic focus

In Immune Medicine, Adaptive said it has built a proprietary dataset of more than 5 million paired T-cell receptors (TCRs) spanning over 20,000 antigens and nearly 50 HLA types, which the company believes is large enough to train predictive models of adaptive immune responses. The company is also applying its platform to identify potential disease-causing TCRs and antigens in autoimmune conditions including type 1 diabetes, celiac disease, and multiple sclerosis.

Robins said the company signed two licensing deals with Pfizer in 2025:

• A data licensing agreement granting Pfizer access to a subset of Adaptive’s TCR-antigen training data for AI and machine learning model development.
• A target discovery-focused licensing deal in rheumatoid arthritis, aimed at identifying autoreactive TCRs enriched in RA patients.

Adaptive also completed a preclinical data package for a lead TCR-depleting antibody program in ankylosing spondylitis but said it made a “strategic decision” to stop further investment in the program and prioritize capital toward data generation and AI modeling.

For 2026, the company said it expects a lower target net cash burn in Immune Medicine of $15 million to $20 million, down from around $30 million in 2025, and intends to pursue additional data partnerships.

Quarterly results and margin progress

Piskel reported fourth-quarter total revenue of $71.7 million and full-year revenue of $277 million, representing 51% and 55% year-over-year growth, respectively. He also noted that, following the termination of the Genentech collaboration in August, remaining amortization was accelerated into Q3 and there are no ongoing Genentech economics in results after Q3.

Excluding non-cash Genentech amortization, Q4 revenue still totaled $71.7 million, up 63% year-over-year, with 86% from MRD and 14% from Immune Medicine. On the same basis, full-year revenue was $235.7 million, up 42% year-over-year.

Sequencing gross margin (excluding MRD milestones, Genentech amortization, and Pfizer licensing revenue) was 71% in Q4 and 66% for the full year, up from 53% in 2024. Management attributed improvement to production efficiencies, labor leverage, and the transition to NovaSeq X Plus.

Operating expenses, including cost of revenue, were $84.5 million in Q4, up 4% year-over-year, reflecting higher MRD sales and marketing investments tied to EMR and market access initiatives, partially offset by lower Immune Medicine R&D. Full-year operating expenses were $334.1 million, down 2% year-over-year.

Adjusted EBITDA was $4.1 million in Q4, compared to a loss of $16.4 million in the prior-year quarter. For the full year, adjusted EBITDA was $12.2 million, compared to a loss of $80.4 million in 2024. Net loss was $13.6 million in Q4 and $59.5 million for the year.

In segment terms, Adaptive said MRD adjusted EBITDA was positive $15.2 million in 2025, compared with a loss of $41.2 million in 2024. Immune Medicine adjusted EBITDA loss improved to $31 million from $37.9 million.

During Q&A, management addressed competition in multiple myeloma MRD testing, arguing that flow-based methods are “inherently less sensitive” than clonoSEQ and emphasizing its stated clinical sensitivity, reimbursement positioning, and community EMR integration footprint. The company also discussed execution drivers for DLBCL adoption, noting it remains early in penetration but citing strong growth in that indication during Q4.

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.

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