Thanks, everyone, for joining us. Pleased to be joined by the Adaptive team. My name is Sebastian Sandler from the Life Science Tools and Diagnostics team at JPMorgan . As usual, we'll have 20 or so minutes of presentation followed by Q&A. And with that, I'll pass it off to Chad. Thanks, Chad.
Thank you, Sebastian, for the opportunity to present at JPMorgan once again. Happy New Year to all of you in the room, and welcome to those of you who are listening on the webcast. As a quick reminder, I will be making forward-looking statements during my presentation, and I and my team will be as well during the Q&A. For those of you who are new to Adaptive, let me give you a quick refresher of who we are. My brother Harlan and I founded the company 16 years ago at the Fred Hutchinson Cancer Research Institute, and we've been public since 2019. Today, we're about 620 employees. We've got more than $275 million in revenue and a strong cash position of approximately $227 million.
Adaptive was built on a simple but powerful premise that if we could read and translate the genetic source code of the adaptive immune system, T-cells and B-cells, we could fundamentally improve how diseases are diagnosed and understood, so as our proprietary platform and underlying technology have continued to advance, we're today focused on two business opportunities that are underpinned by that same core foundation. The first is our Minimal Residual Disease, or MRD business, which is a commercial-stage diagnostic for patients with blood cancer, which is anchored on our clonoSEQ test. The second is our Immune Medicine, or IM business, which is focused on interpreting immune receptor data to drive insights across a broad range of immunology applications, so I want to take a look at each one of these business outlooks, starting with MRD.
We're focused on MRD in lymphoid malignancies, which represents a total global addressable market of approximately $5.5 billion, which spans both the clinical and the biopharma market opportunities. Within clinical testing, our principal commercial focus is based in the United States. It's a market of roughly $1.8 billion, and we see a clear opportunity to expand that market over time. This expansion is driven by increased frequency of testing across the continuum of care. As MRD becomes more deeply integrated into routine clinical decision-making, we believe that we can increase frequency of testing by 2.5 to 3.5 tests per patient per year. That alone would expand the U.S. market by approximately $700 million. It's important to understand the underlying biology that we use to capture this opportunity.
See, clonoSEQ measures MRD and the role that the MRD status plays in enabling highly specific, clinically actionable MRD testing. So, at its core, MRD testing is truly about separating true cancer signal from background noise. So, as tests push sensitivity higher, assays that rely on signals that can be generated by error, so for example, if you're tracking a small number of mutations, inevitably start to generate false positives because the signal gets lost in the noise. So, our testing clonoSEQ largely avoids that problem by leveraging kind of that underlying biology of T and B-cells. So, in lymphoid malignancies, which are cancers of the immune system itself, T or B- cell cancers, each cancer clone carries a patient-specific immune receptor DNA sequence. Think of it essentially as a molecular barcode that is long and highly specific to that patient.
At diagnosis, clonoSEQ identifies that barcode, and over time, we simply count the number of those exact sequences in the blood or bone marrow, and that is Minimal Residual Disease testing. See, but because that sequence or barcode, it's almost impossible to generate by accident. clonoSEQ quantifies MRD with an exquisite level of high sensitivity and specificity, and we essentially have no false positives, allowing the detection of one cancer cell in every million healthy cells. So, it's that biology-driven specificity that differentiates clonoSEQ and lymphoid malignancies. But it's beyond the technology itself. We spent a decade building durable moats around clonoSEQ that reinforce our leadership across both clinical testing and biopharma. First is the regulatory and clinical validation. clonoSEQ is the only FDA-cleared MRD assay in lymphoid malignancies, reinforcing our sensitivity, reliability, and reproducibility in routine clinical care. Second is performance and intellectual property.
clonoSEQ delivers the deepest sensitivity backed by a strong IP position in more than 250 peer-reviewed publications. The third is scale and access. We have coverage representing over 300 million covered lives now, which reduces friction for adoption across the care continuum. And finally, and importantly, is workflow integration. clonoSEQ is now integrated into EMR systems across both academic and community settings. It's not any one of these things that drive our growth, but it's all these things that are taken together that make it incredibly difficult to displace clonoSEQ both clinically and in the biopharma realm. So, I want to take a minute if we look at kind of the financial evolution of the clonoSEQ business. MRD, I'm pleased to say, is now a profitable business. We achieved positive adjusted EBITDA in 2025, followed by positive cash flow. This was a super important inflection point for the business.
Revenue has scaled consistently over time with a 34% cumulative average growth rate from 2021 - 2025 and now surpasses $200 million. Within that, clinical revenue has grown at a 53% CAGR, reflecting strong adoption and increasing utilization. But at the same time that we're growing the top line, we're also growing our margins. Gross margin has improved significantly. It's driven by our lab efficiencies, and last year, our transition to the NovaSeq, and we've generated clear operating leverage across our entire commercial organization. But importantly, although we've grown a lot, we see a path for continued improvement across all of these metrics into 2026 and the years beyond. So now I want to, I'll zoom into clinical testing first and the metrics that are going to continue driving this performance.
Clinical volumes have grown consistently year-over-year, delivering a 44% CAGR since 2021, driven by broader indication adoption, expanding access across the United States, and EMR integrations. We've now surpassed 100,000 patients who have been tested with clonoSEQ to monitor their disease. And in 2025, over 50% of U.S. h eme-oncs have used a clonoSEQ test. Importantly, even with that momentum, penetration remains really relatively early. If you think about it, our largest indication, which is ALL, is only 35% penetrated, and all of our other indications are less than 15%, with several still in the single digits. So it's really that combination of our strong volume growth and this potential headroom is what kind of underpins the durability of our business moving forward. So I'm going to walk through the factors that are going to contribute to our volume growth in the future.
So clinical volume growth is driven by a combination of five interrelated factors that are shown on the slide. Those drivers are blood-based testing, expanding presence in the community, clinical guideline inclusion, ongoing data generation, and very deep EMR penetration. It's what's key is that no one single factor is driving our growth on its own. All of these factors reinforce each other, which increases our physician adoption and the testing frequency per patient across all of these indications. So I'm going to touch on each one of these growth drivers separately. But as a matter of fact, the first two growth drivers are highly intertwined, which are blood-based testing and are increased in the community hospital setting. So as MRD increases in the blood, it becomes more accessible in the community setting, where the vast majority of testing is done in blood rather than the bone marrow.
Blood testing is also less invasive and obviously easier for patients, which supports more frequent testing over time per patient, so our focus on blood adoption has three components to it. The first is continued growth in blood-based indications like CLL, DLBCL, and MCL. The second is ongoing data generation in blood, which reinforces clinical confidence, and the third is enhancing our assay in the blood, particularly in multiple myeloma, so today, about 45% of all clonoSEQ tests are already blood-based. We expect that number to increase to over 50% by year-end. Similarly, about 30% of clonoSEQ testing comes from the community setting today. We expect that to grow over the year to over 35%, so, I mean, given that roughly over 60% of heme-onc patients, sorry, hematology patients are treated in the community, increasing penetration in this setting will drive a broader adoption across all of our indications.
So the next driver is guidelines. And 2025 was really a fantastic year for us in guidelines. At a high level, these updates expand the role of MRD really from a supporting test to a test that's used as a clinical decision-making tool. So I'll just walk through a couple of them, although we had guideline updates in all five indications. But just to mention a couple, in multiple myeloma, the recommendation to obtain a clonality or ID testing at diagnosis was really strengthened this year in the guidelines. That matters a lot because it reduces the friction to completing the ID testing upfront, which is required for the downstream MRD monitoring. And it supports broader adoption, particularly, as we mentioned, in the community setting.
In CLL, MRD was elevated from a research assessment to a clinical decision-making tool with more explicit guidelines on serial testing, including assessments every three to six months. We see this as a meaningful step for clinical utility for clonoSEQ for the first time in CLL. Our medical team has been really great about actively engaging with the guideline committee, and we expect to have future guideline inclusions over this year and beyond. Really, that brings us to the next topic, which is also interrelated, which is data generation. Data generation is a really powerful and meaningful tool for clinical adoption. In 2025, again, marked an all-time high. At ASH this year, nearly 90 abstracts featured clonoSEQ data with a clear emphasis on MRD as an interventional tool.
It's not just prognostic anymore, but it's actively guiding treatment decisions across indications and across the continuum of care, so we're seeing MRD being used to inform treatment decisions, intensity, and frequency, and these decisions are included throughout the care continuum, including decisions around transplantation, consolidation therapy, and in maintenance therapy, so again, I'm not going to walk through all 90, but I'll give you a few examples to highlight kind of the practice-changing data, so let's start again with our largest indication in multiple myeloma. The MIDAS study, it included nearly 900 patients and demonstrated that MRD-negative patients can safely forego a transplant without compromising depth of response, so this represents one of the strongest prospective data sets supporting MRD-guided decision-making in myeloma, period. In pediatric ALL, the NRAD study showed that patients who are MRD-negative may be able to choose transplant approaches without radiation.
Obviously, this is incredibly important for children and their families. So if you take kind of all of these factors together, these data continue to strengthen clonoSEQ's role in MRD-informed patient management and drive sustained utilization over time, so now that I've covered clinical volumes, I want to actually, let's go to the one last point, which is EMR integration, which is perhaps one of the most important factors to drive our growth. So embedding clonoSEQ directly into EMR workflows, both across the academic and in the community settings, it materializes our friction and expands access and really supports repeat usage per patient, so but what is integration? If you look at it, what does it really deliver and how does it work? So first is accelerated volume growth. In 2025, most integrated accounts grew roughly twice as fast as non-integrated accounts.
As EMR integration becomes more widespread, we expect these to contribute more than 50% of our 2026 volume. So second is, if you think about using a test and it being part of a portal that kind of you wheel over to your, that the physician wheels over, it has this durability and stickiness. Being embedded into the EMR makes clonoSEQ part of routine clinical care workflow, and it reduces disruption from provider turnover, and it's really a huge barrier to entry. Third, operational efficiency. Within our 10 largest integrated Epic accounts, we've seen a reduction of about 40% in our order discrepancies, which really improves the order experience for both clinicians and for our lab in-house. And finally, higher testing frequency. We're able to kind of pre-configure order sets now, particularly in Flatiron and in the community, to allow for repeat ordering of every three, six, or twelve months.
That makes it a lot easier to do repeat testing. This is a number that I'm really thrilled to announce that over kind of 75% of community oncologists have placed orders using serial monitoring. Again, now that we actually have covered all of the aspects of clinical volume growth, let's turn to the other side of the equation, which is average selling price or ASPs. Again, brief refresher. Kind of at the start of 2025, the updated Medicare gapfill rate of $2,007 per test went into effect. That was up from $1,700 per test. As that change kind of flowed throughout the year with continued improvement and reimbursement execution, our average ASP reached approximately $1,310 in 2025, which would represent a 17% year-over-year increase. I'm going to put this out now.
We've talked about this before, but I'm going to reiterate that we see a clear path to $1,700-$1,800 ASP by the year 2029. And this is really defined by a couple of different factors, which I'll again touch briefly on. The first is policy expansion. So we're continuing to broaden our commercial coverage, particularly in CLL and in non-Hodgkin lymphoma. The second is contract negotiation and renegotiation. Kind of we're systematically updating our existing contracts, and we're closing new agreements at the updated rate. We had several wins in 2025 that will contribute to our 2026 ASP growth, and we're in a kind of late-stage negotiation with two large national payer contracts. The third is this concept of recurrence monitoring. So this expands coverage beyond our single Medicare episode.
In 2025, we received our first Medicare approval for recurrence monitoring in MCL, which created a clear pathway to expand this year, 2026, into CLL, followed by DLBCL, and ultimately, we expect to have recurrence monitoring in multiple myeloma, and finally, just kind of blocking and tackling, think revenue cycle management, so we've had ongoing improvements in Medicare Advantage building, in Medicaid collections, our appeals process, our prior authorization, and we've been really good on our turnaround times and time to cash. This is a cool area that's increasingly supported by our AI efforts, so again, it's not one of these factors, but all these factors together support this continued ASP expansion and give me a high degree of confidence in that $1,700-$1,800 number by 2029.
So now that we've covered the clinical side of the business, I want to turn kind of your attention to the MRD pharma business. Our MRD pharma portfolio today is anchored in multiple myeloma, where MRD has achieved formal acceptance as a clinical endpoint, and clonoSEQ is incorporated into most all pivotal trials, so as a result, in 2025, about 70% of our sequencing and revenue and about 60% of our backlog came from multiple myeloma studies. This reflects both the maturity of the indication, but also the depth of our biopharma partnerships, which we started kind of 10 years ago, but at the same time, and kind of meaningfully important, we're seeing a diversification beyond myeloma, particularly in CLL and DLBCL, so in CLL, bookings in 2025 more than tripled year-over-year, and the pipeline continues to build.
This is supported by updated NCCN guidelines, which we talked about for fixed duration regimens and emerging data that highlights the need for higher sensitivity in MRD to differentiate between therapies. In DLBCL, MRD remains a little bit earlier, but the pipeline opportunity is really very significant. It's increasing our companion diagnostic opportunities and our registrational trial activities is driving demand for a standardized, FDA-validated, and globally deployable MRD assay. Our focus is on generating first-line post-treatment MRD data to accelerate our adoption curve. So importantly, we've also seen our bio portfolio expanding towards registrational trials. So remember, in April 2024, following the FDA ODAC recommendation that supported MRD as a primary endpoint in myeloma for accelerated approvals, the number of clonoSEQ studies using MRD as a primary second endpoint for the first time for us has surpassed research-only studies. This is really, really important because this shift matters economically.
So if you think about it, for us, registrational trials, they carry a lot higher value because the average price per sample is higher, and we get milestones based on the readouts of these FDA-approved drugs. So we expect this trend to continue as MRD is used more interventionally in trials across diseases, and as our sponsors, the pharma companies, are increasingly requiring higher sensitivity NGS assays to differentiate therapies. So if you take all this together, kind of both across both the clinical and biopharma business, we built a very durable MRD platform with multiple growth drivers that are now firmly in place that will continue out into the future. So with that foundation in place, let's look at some of our expectations for the MRD business in fiscal year 2026. First, we expect clinical testing volume to grow by more than 30% year-over-year.
If you recall last year, we're kind of following the same playbook, where last year we came out with 25% + and said circle the plus. So we do expect it to grow, clinical volume to grow more than 30% this year. Second, we expect fiscal year ASP of approximately $1,400, reflecting continued progress across coverage, contracting, and our reimbursement execution. Third, we expect mid-single-digit millions in milestone revenue. Remember, as always, we're conservatively guided on milestone revenue, given that really trials are ultimately out of our control for approvals. And finally, we expect to see sequencing gross margins continue to improve, and we do expect to reach over 70% gross margin for fiscal 2026 that will be driven by scale and our ongoing operational efficiencies, including the NovaSeq implementation, which went live in the back half of 2025.
So again, as always, we're going to provide kind of more full-color additional details on company guidance when we report our full year and audited Q4 in February. So now that we've covered MRD, I want to switch to our other business unit, which is Immune Medicine. Again, so for those of you who are newer to Adaptive, we spent over a decade building technology and generating data to connect the adaptive immune system response to diseases. At the center of that effort is a fundamental challenge: understanding how T-cell receptors bind to antigens and how those interactions drive the immune response against cancer, autoimmunity, and infectious diseases. So this is truly a problem that's defined by scale. There are billions of distinct T-cell receptors interacting with millions of clinically relevant antigens, which is a problem that makes it incredibly well-suited for AI and machine learning.
Given our proprietary immune receptor platform and the magnitude of the data we've generated, Adaptive is uniquely positioned to address this challenge. Last year, we shared that we mapped roughly two million T-cell receptors to antigens. Today, that's grown to more than five million paired T-cell receptors, spanning over 20,000 antigens and nearly 50 HLA types, well beyond what's publicly available in all of the literature combined. At this scale, we believe, in coordination with many experts in the field that we've spoken to, that this dataset is now sufficient to train predictive models of the adaptive immune response across many different diseases. Importantly, we're also generating biological insights. Using this platform, we're identifying disease-causative T-cell receptors and their antigens in various autoimmune diseases, including type 1 diabetes, celiac disease, multiple sclerosis, and ankylosing spondylitis. Now we're beginning to monetize that immune receptor data.
The two recent agreements with Pfizer show two ways on how our data create value in distinct ways. The first is data licensing. Pfizer is licensing a subset of our TCR antigen training data focused on specific HLA types to support the development of their AI machine learning models. The second is in target discovery. In rheumatoid arthritis, Pfizer is using our Immune Medicine platform to identify disease-specific T-cell receptors, so using these patient samples provided by Pfizer, we're applying our sequencing and immunology capabilities to identify those T-cell receptors enriched in rheumatoid arthritis with a goal of informing future therapeutic development for Pfizer, so I want to kind of clearly state that these partnerships provide early validation of both the scale of our data and the strength of our platform, but ultimately don't necessarily represent the end game.
We look forward to deepening our work with Pfizer and advancing discussions with other partners that are interested in data, our mapping capabilities, and our predictive models. So if you look at 2025, we're really quite pleased with the progress we delivered in Immune Medicine, but we did this with a very disciplined capital deployment and management with a cash burn of approximately $30 million. So checking them off, during the year, we meaningfully scaled our TCR antigen dataset to five million, as we said, paired sequences. We executed two data agreements with Pfizer, and we completed a preclinical data package for our lead TCR depleting antibody program in ankylosing spondylitis.
So while the next step in our antibody program would have been IND-enabling studies, we have made the decision to prioritize investment in data generation and predictive modeling, where our core expertise lies and where we see the highest return on adjusted capital. Excuse me. So as we look ahead to 2026, we expect to execute on this strategy with a lower cash burn of between $15 million and $20 million while continue to invest selectively in our TCR antigen data, which we believe represents meaningful long-term upside for Adaptive. With that, I want to leave you with three key takeaways. The first is in MRD. We're continuing to strengthen and extend our leadership position in MRD testing for blood cancers. With clear momentum across volumes, ASPs, and margin, our focus is on capturing market growth while we continue to expand our MRD profitability. Second, Immune Medicine.
Here, our priority, as I just mentioned, is advancing our immune receptor data platform and executing it on targeted monetization opportunities that build long-term strategic value and third, and perhaps most importantly, and perhaps exciting to folks in this room, is financial execution. Based on the progress we've seen around the business, we expect to achieve positive adjusted EBITDA and positive free cash flow for the entire company in the year 2026. This obviously represents a major milestone for Adaptive, and it reflects the discipline and the durability of our model. With that, thanks for listening today, and I'll hand it back over to Sebastian for the Q&A.
Great. Thanks for that overview, Chad. Lots to dig into. Maybe we can start with the 4Q performance. So clonoSEQ volumes came in nicely at around 30,000 tests for the quarter. I think that's a record sequential step up.
So maybe can you just dig into the performance seen there, maybe across the different settings, so community versus academic? I'm curious how much of a role the Flatiron integration had. And then any color on blood testing and any indications that stood out would be really helpful.
I'm sure, Susan, you want to take it?
Sure. We were really pleased to see the Q4 performance, and I think it was really an intersection of all of the drivers that we've been focusing on for the last several years coming together in really an optimal way. In terms of the Flatiron integration, I do think that with an additional three months of experience, as you remember, we launched in July, we were able to start really seeing some of the benefits of that, particularly in the serial testing element that Chad alluded to earlier.
As a result, we saw 18% quarter-over-quarter growth in the community settings. It was an acceleration of growth in the community. Blood-based testing also played an important role both in expanding community use and in increasing testing frequency. We saw overall test contribution of blood-based testing increased to 47% in Q4. In myeloma, which is a traditionally marrow-based indication, we saw it grow to 27%. All of these factors, along with the strong guidelines updates that Chad alluded to, data generation between ASCO, ASH, and other meetings, and the other EMR integrations that we've done, I think contributed to one of the best Q4s we've seen.
Just briefly, that's Susan Bobulsky, who runs our MRD business, Kyle Piskel, our CFO, and Harlan Robins, our Co-founder and Chief Scientific Officer.
Maybe looking ahead to 2026, or not looking ahead, so nice starting out with at least 30% growth in clonoSEQ volumes. Can you walk through what's embedded there from community versus academic? You've called out the Neo partnership as being a driver of future volumes, so maybe the latest there. And then how maybe the guideline updates from 2025 could start flowing through and keep solid traction there.
Okay, you want to keep going?
Sure. So in terms of the 2026 guide, anticipating continued growth in both the community and academic settings, we do intend to further increase the contribution of community, growing to 35% by the end of the year, as was noted in the presentation. The NeoGenomics partnership, which we've been working very hard on over the last month or year or so, has continued to generate insights through pilot work that we've done with selected accounts.
We also did our first joint integration in a large community account, which contributed to some significant growth we saw there in Q4. The next step here is to integrate insights from the pilot into our end-to-end workflow and then make a determination of when we're ready to go to a broader launch, and because we haven't made the final decision as to when we'll do that, we decided to, rather than incorporate Neo into our guidance, to rather treat it as upside. This will be the first time we're doing anything like this, and so we'll have more to say as we know more about timing and the full scope, and then guidelines was the last thing you asked about, Sebastian. Guidelines in 2026 will be largely a pull-through effort. There's a lot of education to do around the many updates that came through in 2025.
And then also we do anticipate potentially an update from the International Myeloma Working Group, which is a very influential global body. They have been working on updates for over a year and have signaled that they'll be publishing those in the near future. So keep an eye for those. I think there'll be some nice positive incorporation of MRD into treatment response criteria.
Great. Maybe sticking on the topic of educational efforts and sales and marketing. So 2025 milestone year for profitability in the MRD business. Looking ahead, how should we think about the framework for balancing profitability and top-line growth? Can you talk about the operating leverage you think we could see on the business in 2026 and a cadence for maybe adjusted EBITDA margins as we progress through the year?
Kyle, you want to take that?
Sure. Thanks for the question.
As it relates to operating leverage, we continue to expect to see expanding operating leverage across the business. I think while we may not hold our operating expenses flat like we have done the last couple of years, we do expect to make additional investments to serve the existing business and to continue to grow the business, which we are very excited about, but we still expect to see significant uptake in operating leverage. We'll get additional leverage, as we mentioned, around the sequencing margins through the NovaSeq as we continue to add additional volume. We still think there's additional leverage in the sales and marketing line, even though we are going to make some additional investments to continue to grow and penetrate into the markets we're serving. As it relates to adjusted EBITDA margins, we'll continue to provide some color around that in February when we get full results.
Okay. Maybe digging more into guidelines. There's a lot to cover, but I want to touch on CLL specifically since there's a nice addition there to look at MRD-guided regimens. I guess first question is, how should we think about the volume impact there in 2026? And a company has submitted for FDA approval of the VENCLEXTA regimen with acalabrutinib. So what is the dynamic there with these guidelines coming out ahead of FDA approval? Do you see that as a hurdle to get over, or are you starting to see good traction there with the guideline update in place?
We're very excited about the guidelines update in CLL, particularly because it's the first time that any frequency recommendation has been incorporated. The suggestion is every three to six months during a therapy that could potentially be time-limited.
The MRD-guided regimen component, as you noted, is a little in advance of a potential FDA approval of those regimens. But in academic settings, those regimens are already actively utilized. They are likely to be covered based on being included in NCCN guidelines. And the community is eagerly awaiting the opportunity to switch from a single oral forever therapy to a combination oral time-limited therapy. So there's a lot of excitement, and I think a lot of tailwinds coming through the treatment landscape in 2026. It will take time to educate on guidelines, but we will certainly be putting a lot of muscle behind that. And for the first time in a while, I think we feel CLL has some real opportunity to accelerate.
Great. Maybe touching on competitive dynamics in hema MRD, I think there's been a little more noise around that recently following an acquisition in the space.
Adaptive has historically enjoyed limited NGS competition there. Has anything fundamentally changed in your view over the last couple of months? How do you view the competitive moat and the runway, especially as it relates to data generation?
Maybe I'll start and take kind of the broader perspective. Then, Susan, if you want to dig into any of the points, please do so. But remember, in the area, and let's be specific, Natera acquired a company called Foresight Diagnostics. They play specifically in the area of DLBCL with a circulating tumor DNA assay. In general, in DLBCL, this is a nascent market. NGS MRD really isn't being done or it's just starting. And this represents a really large market opportunity. And so penetration into the market, we think, will disproportionately benefit Adaptive in our clonoSEQ test, right? Because we have reimbursement in place.
The biology of our test, which I alluded to, or actually was pretty specific on during the presentation, that we are specifically tracking the VDJ rearrangement, which leads to a very high specificity of the test and low false positive. We think that's a competitive dynamic that will play out in Adaptive's favor as data starts to emerge. However, even without that, like I said, this is an area where kind of all boats are going to rise on the tide. But again, I think we're going to disproportionately benefit because the standard of care right now in DLBCL is actually PET scan. So they're not doing NGS MRD. However, if you look at the competitive dynamic, what's changed?
And one of the reasons, one of the many reasons, including our kind of overall financial performance, what we decided to announce early is because we had a 14% growth quarter-over-quarter and 114% growth year-over-year in DLBCL. So this is an area that we feel is extremely ripe to be able to really capture the market and over time dominate market share.
Great. Very helpful. Maybe on ASPs and MRD, so you laid out the long-term target of $1,700-$1,800. Maybe can you touch on which indication do you think have the most room for improvement? And then I saw you filed for recurrence monitoring coverage for CLL. So can you talk about how conversations are progressing there? And then is this embedded in the outlook for 2026 of ASPs around $1,400?
You can start.
Sure. I'll start. To clarify, we haven't filed for CLL.
It's one of the objectives for 2026, but as it relates to the walk on ASPs in 2026, I think there's a couple of dynamics as it relates to indications. It's continuing to see expanded coverage on the commercial front in DLBCL and MCL in particular. We'll see additional lift as we get to see additional coverage lift, whether that's coming from guidelines or directly from LBMs who inform the decision at the commercial payer policy level. The other piece, which is a dynamic that played out a lot through 2025, is recontracting efforts. We still have two large national payers, which Chad mentioned, who we're continuing negotiations with in terms of getting a rate reset, and so that's a dynamic we're expecting to go in our favor at some point, but timing's a little difficult to predict on that, so that's kind of implicit in our guide.
We're going to continue to see lift from some of the RCM initiatives we've put in place in 2025 that we continue to put in place in 2026 to drive ASPs forward.
Great. Maybe one more on MRD on testing frequency. I think currently it's around two to two and a half tests per patient. I think it looks like you think this could get up to three, three and a half tests over time. Can you talk about how this splits out by indication? Is this driven mostly by blood testing? Does that factor in recurrence monitoring? Just kind of what are the puts and takes there?
We do think there's an opportunity to increase testing frequency across all of our indications, although to your point, it does depend to some extent on the type of sample that is typically utilized and also the aggressiveness or lack thereof of the disease, so currently, we see the most frequent testing in ALL, which is an extremely acute disease, very serious and requires vigilance from day one of post-diagnosis. There is an opportunity there to increase testing further based on the utilization of blood as a complement to bone marrow, and experts are increasingly rallying around that concept, and the NCCN recently incorporated that guidance to consider blood in addition to bone marrow. On the flip side, CLL has historically been one of the least frequent testing because the disease is indolent.
There wasn't as much urgency to monitoring, although as I noted earlier, the landscape is shifting to support more frequent testing in the context of potentially time-limited and custom duration therapies driven by MRD. Overall, we do believe that there's an opportunity to increase frequency of testing. We will be pursuing recurrence monitoring coverage across indications to support continued ASP expansion over time, particularly for Medicare patients. Our commercial payers importantly do cover single time points, so we don't have a limitation on the number of tests we can get paid for in the commercial setting. And then I think the pharma utilization of CLL, which, as Chad noted, we saw tripling of our bookings in 2025 versus prior year. That will be also synergistic in supporting the adoption of MRD testing in the clinic.
Great. Maybe one last one quickly on the IM business.
I think a definite shift to more focus on data licensing. You obviously announced the Pfizer agreement. Just looking ahead to 2026, could we see similar agreements with other pharma companies? What are you most excited about for that business looking ahead?
Sure. Thanks for the question. We're excited on the data side, both for potential other partnerships, but also what we're able to do in-house, which includes making progress on generating more of the training data, but also applying models to advance in our own right and then connecting them to disease. So I think both internal and external, we're hoping will be a really nice year for us.
Great. I think with that, we're out of time. Thank you to the Adaptive team, and thank you all for being here. Have a great rest of the conference.
Thanks, Sebastian.