Participants

Karina Calzadilla; Vice President - Investor Relations; Adaptive Biotechnologies Corp

Chad Robins; Chairman of the Board, Chief Executive Officer, Co-Founder; Adaptive Biotechnologies Corp

Kyle Piskel; Chief Financial Officer; Adaptive Biotechnologies Corp

Susan Bobulsky; Chief Commercial Officer, MRD; Adaptive Biotechnologies Corp

Mark Massaro; Analyst; BTIG

David Westenberg; Analyst; Piper Sandler Companies

Sebastian Sandler; Analyst; JPMorgan

Tom Stevens; Analyst; TD Cowen

Corey Rosenbaum; Analyst; Scotiabank

Maggie Bouie; Analyst; William Blair

Presentation

Operator

Good day and thank you for standing by. Welcome to the Adaptive Biotechnologies first-quarter 2025 earnings conference call. (Operator Instructions) Please be advised that today's conference is being recorded.
I would now like to hand the conference over to your first speaker today, Karina Calzadilla, Head of Investor Relations. Please go ahead.

Karina Calzadilla

Thank you, Antoine, and good afternoon, everyone. I would like to welcome you to Adaptive Biotechnologies first-quarter of 2025 earnings conference call.
Earlier today, we issued a press release reporting Adaptive financial results for the first quarter of 2025. The press release is available at www.adaptivebiotech.com. We are adopting a live webcast of this call and will be referencing a slide presentation that has been posted to the Investors Section in our corporate website.
During the call, management will make projections and forward-looking statements within the meaning of federal security laws regarding future events and future financial performance of the company. These statements reflect management's current perspective of the business as of today.
Actual results may differ materially from today's forward-looking statements depending on a number of factors which are set forth in our public filings with the SEC and listed in this presentation. 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.
Joining the call today are Chad Robins, our CEO, Co-Founder; and Kyle Piskel, our Chief Financial Officer. Additional members from management will be available for Q&A.
With that, I'll turn the call over to Chad. Chad.

Chad Robins

Thanks, Karina. Good afternoon and thank you for joining us on our first-quarter earnings call.
As highlighted on slide 3, we are off to an excellent start this year, demonstrating strong execution across both top and bottom-line results. In MRD. revenue increased 34% from a year ago. Significant growth was observed in clinical volumes, ASP, and pharma sequencing. This quarter, we also received our first Medicare recurrence monitoring coverage in MCL, a key part of our strategy to grow that lifetime value of each clonoSEQ Medicare patient.
In Immune Medicine, we're making progress on our preclinical antibody program in autoimmunity. Sequencing gross margin improved by 17 percentage points year over year to 62%. At the same time, operating expenses decreased by 9%, underscoring our disciplined cost management while driving strong, sustainable growth. As a result, cash burn for the quarter was $23 million, a 38% improvement compared to the same period last year.
Given the strength of our performance and sustained momentum, we are raising our full-year guidance to reflect, one, a higher MRD-revenue range; two, lower operating expense range; and three, a lower annual cash burn. Kyle will provide more detail during his remarks. Of note, our full-year outlook has minimal exposure to tariffs, trading policy updates, and a funding pressures. Importantly, I want to highlight our solid cash position of $233 million. We believe our cash on hand provides ample runway to achieve our strategic objectives without the need to raise additional capital in the current market environment.
Let's now take a closer look at the MRG business on slide 5. Currency clinical revenue, the first quarter grew 55% versus prior year. Tests delivered reached a new record high of over 23,000 in the quarter, representing a 36% increase versus prior year and a 10% increase sequentially. Growth was once again observed in all reimburse indications. Multi-myeloma continues to be the largest contributor of U.S. closing volume at 42%, followed by ALL at 33%, CLL at 10%, DLBCL at 7% and MCL at 5%.
Looking at other key growth metrics in the quarter, it's encouraging to see the positive trends that align with the successful execution of our strategy. Blood-based testing contributed 44% of MRD test in the US versus 39% a year ago. The increase was primarily driven by strong growth in DLBCL and MCL tests in the community grew 42% versus prior year and 14% sequentially.
NHL contribution jumped to 12% from 10% a year ago, driven by continued ramp in MCL and the launch of our enhanced assay and DLBCL. The number of ordering health care providers grew 31% from the prior year is now over 3,400, and our pace of EMR integrations is accelerating. We now have 27 live integrations, including 5 of our top 10 accounts. We expect to add at least 5 more accounts in the next month. We are seeing a notable lift in individual account growth rates, post integration, and growth in integrated accounts is outpacing growth in non-integrated accounts.
In addition, we're making solid progress on our initiatives to increase clonoSEQ ASP. In Q1, ASP was north of 1,220 per test, representing a 14% year-over-year increase. Importantly, we closed and/or renegotiated six key agreements with major national payers, including Aetna, Humana, Anthem, Horizon, and two of the Blue Cross Blue Shield programs.
Alongside these payer wins, we've expanded our reimbursement operations team and continue to optimize revenue cycle management. Given this progress, we are confident in achieving an average ASP of $1,300 per test for fiscal year 2025, setting us up for continued future ASP growth.
Looking at MRD pharma on slide 6, our MRD pharma business had a strong start to the year, with sequencing revenue grew growth of 11% versus prior year. This quarter, we also recognized $4.5 million in regulatory milestones. We continued to see significant momentum following the ODAC recommendation and multi-myeloma last year.
As you can see from the chart, over 60% of our portfolio today is a multi-myeloma, including 22 new studies, which closed in the last 12 months. The majority of these studies are using MRD as a primary or secondary endpoints, so they tend to be larger Phase 2 and 3 studies often with large milestones attached.
We're also seeing a halo effect from this decision in other disease states like CLL, where treatment advances are necessitating more sensitive MRD assessment in clinical trials. Additionally, we see growth opportunities for the pharma business and DLBCL as multiple companies are preparing to advance MRD-directed therapy.
To wrap up on MRD, we achieved strong results for the quarter in both our clinical and pharma businesses. As shown on slide 7, the stage is set to achieve our full-year strategic goals. We are on track to end the year over 45% of clonoSEQ testing done in blood plug. We are on track with EMR integrations, including onco EMR launch with Flatiron in the second half.
We are on track to begin Phase 1 testing with NeoGenomics' in an initial set of accounts in the second half of the year. We're on track to go live with NovaSEQ X in the second half of this year, and we continue to have key data readouts span in multiple indications. Importantly, we are on track to be adjusted EBITDA positive in the second half of this year.
Now let's turn to Immune Medicine on slide 9. Our Immune Medicine business focus on two differentiated immune-based therapeutic strategies. One is in cancer with our partner, Genentech. The second is in autoimmunity based on our highly targeted precision immunology approach.
Our focus this year is on three main goals. First, to generate the size and quality of data to successfully develop a digital TCR-antigen-prediction model that supports a cancer cell therapy program with Genentech. As we successfully scale our data, we're also making good progress in training and improving the performance of our AI and ML models.
We're aiming to replace our TCR discovery cellular assays that digital model that can rapidly and accurately predict TCR antigen binding. This has the potential to meaningfully reduce both time and cost for selecting the best TCRs to include in hand for cell therapy, among other future, your potential high-value therapeutic applications.
Our second goal is to build a robust preclinical data package for our lead T-cell depletion program in autoimmunity. We're in the process of testing and characterizing a subset of promising antibody candidates in our lead indication.
The third goal, as we execute on these two focused therapeutic strategy, we are managing to a target immune medicine cash burn between $25 million and $30 million. We continue to strategically gate our IM R&D investments and grow our pharma business revenue to partially fund the spend.
Now, I'm going to pass it over to Kyle to walk through the financial results and our updated full-year guidance. Kyle.

Kyle Piskel

Thanks, Chad.
Starting on slide 10, with results for the first quarter. Total revenue was $52.4 million, representing 25% growth from the same period last year. 83% of revenue came from MRD of 17% from the Immune Medicine. MRD revenue grew 34% versus prior year to $43.7 million, with clinical and pharma contributions of 65% and 35%, respectively. clonoSEQ test volume, including international, increased 36% to 23,117 tests delivered versus last year, and ASP in the US grew approximately 14%.
MRD pharma revenue grew 7% versus prior year to $15.2 million, inclusive of $4.5 million in milestones. On Immune Medicine revenue was $8.7 million, down 6% a year ago, driven by an anticipated 23% decrease in Genentech amortization, partially offset by a 12% increase in IM pharma and academic services.
Moving down to P&L. Sequencing gross margin, which excludes milestones and Genentech amortization, was 62% for the quarter. This represents a significant improvement of 17 percentage points versus prior year as we leverage lower overhead costs and stable direct labor supporting increased volumes while improving pricing across both our clinical and pharma revenues.
Total operating expense for the quarter, inclusive of cost of revenue was $82 million, representing a 9% decrease from last year. This decrease was mainly driven by lower R&D spend from both MRD and the Immune Medicine businesses.
As you can see from the segment reporting table at the bottom of the slide, MRD adjusted EBITDA is now at a loss of $4.1 million versus a loss of $17.3 million a year ago. This improvement of 76% is driven by both higher revenue and lower operating expense and the Immune Medicine adjusted EBITDA loss was also improved 21% versus Q1 of last year due to reductions in operating expense.
Total company adjusted EBITDA was a loss of $12.7 million in first quarter compared to $28.2 million in the prior year. Interest expense from our royalty financing agreement with [our roadmap] was $2.9 million, which was slightly higher than interest income. Net loss for the quarter was $29.8 million.
Now let's turn to our full-year 2025 updated guidance on slide 11. We are raising our full-year MRD revenue guidance to a range of $180 million to $190 million, up from our previous range of $175 million to $185 million. This increase is driven by stronger-than-expected clinical volume performance in the first quarter and higher MRT milestone payments anticipated for the year.
Given the strong clonoSEQ test volumes in the quarter and the momentum we are seeing, we now expect approximately 30% growth in 2025 volume versus 2024, and we anticipate sequential growth in the remainder of the quarters. We also expect revenue from MRD milestones to be between $8 million and $9 million, up from our previous guidance of $6 million to $7 million.
With respect to revenue trends throughout the year, we now expect MRD revenue to be approximately 45, 55 weighted between the first and second half, respectively. We are also lowering our full-year total company operating expense guidance, including cost of revenue, to a range of $335 million to $345 million, down from the previous range of $340 million to $350 million. We continue to expect approximately 69% of the spend to be driven by the MRD business and 23% by the Immune Medicine business with the remainder attributed to unallocated corporate costs.
Lastly, if we are also lowering our full-year total company cash burn guidance to a range of $50 million to $60 million, down from the prior range of $60 million to $70 million. This improvement is prime generally driven by higher-than-expected MRD revenue and reduced unallocated corporate burn. We now expect approximately 24% of this year's cash burn to come from the MRD business, still anticipate burn from the Immune Medicine business to be between $25 million and $30 million for the remainder attributed to unallocated corporate costs.
We remain focused on disciplined execution to drive sustainable growth while managing our resources responsibly, and I look forward to providing you with further financial updates throughout the year.
With that, I'll hand it back over to Chad.

Chad Robins

Thanks, Kyle.
Our strong first-quarter results underscore the focus, agility, and execution of our team for operating from a position of strength and have high confidence in our ability to deliver on our raised full-year guidance. As we look ahead, we remain committed to delivering on our promises and creating lasting value for both patients and our shareholders.
I'd like now to turn the call back over to operator and open up for questions.

Question and Answer Session

Operator

Thank you. At this time, we will conduct a question-and-answer session. (Operator Instructions)
Meg Sykes, Goldman Sachs.

Thanks for taking our questions. You've got Will on for Matt here. Congrats on the quarter and appreciate the color on the 30% volume growth with sequential improvement over the course of the year.
Just wanted to dig a little deeper there. Are there any specific indications you're seeing gross? And how are you seeing contribution from each of the indications trending over the course of this year?

Chad Robins

Yes. Thanks, Will. I'm going to hand it over to Susan.

Susan Bobulsky

Thanks for the question. Yes, we're seeing sequential growth across all indications. We had particularly strong quarter for our lymphoma indication, DLBCL and mantle cell lymphoma. You'll recall that we've launched the mantle cell indication just in Q4 and two are seeing a nice conversion of the promotional effort over the last two quarters. And then in DLBCL, we launched an enhanced version of our assays and also saw the availability of our assay in New York State under court approval become live in Q1. So a number of factors that contributed there.
In terms of contribution across the indications, over the last, let's say year, quarter by quarter, the contribution has remained relatively stable where we're seeing the uptick in DLBCL and NPL, which now contribute a total of 12%, as Chad noted, versus 10% a year ago, mostly taking from other indications. And we've made, as you know, a concerted effort to move our business further toward our Medicare-covered indications. So that's actually a great shift that we've been able to see.

That's super helpful. And then just as a follow up, you touched on the EMR integration on the call. I know last we talked about like 30%-plus improvements in the smaller customers and waiting for updates on some of the larger ones. Are we ready to give updates on the larger ones or quantify the uptake you're seeing there?

Susan Bobulsky

I do have a few more updates and I can share. So we've started to analyze the data across both accounts that have been live for at least one year, and then also now have 5 of our top 10 largest accounts and integrated, several which just went live in Q1, but I can share some data.
So first, let's start with accounts that have been live for at least a year. Yes, these are generally smaller accounts but there are a couple of larger ones in there as well. Six of those seven accounts exceeded 75% year-over-year growth over the past year since going live. And, in total, the volume in that group of accounts went -- more than doubled over the past year.
Among the newer sites that went live, let's say, went live in the past quarter, which included three of our largest accounts. We saw an average quarter-over-quarter growth of 27%, and that exceeded the 18% we saw in the same sites a quarter immediately preceding integration. So we are seeing -- continuing to see an acceleration, I think particularly in those large accounts, those growth rates are quite -- I'm quite pleased with them.

Really impressive results are. Thank you for the color.

Chad Robins

You bet.

Operator

Mark Massaro, BTIG.

Mark Massaro

Hey, guys, thank you for taking the questions. I wanted to start with the strong performance on the core clonoSEQ volume number. It looks like it was up, I think, 2000 tests sequentially. Other labs in the space have talked about whether I think we're seeing impacts of roughly 100 bps to 150 bps across other reference labs.
So I'm just curious how to do drive the growth. Where did it come from? I know you talked about a larger contribution from clonoSEQ blood, but maybe could you spell out if you had a weather impact in Q1?

Susan Bobulsky

Sure. I can take that. Thanks, Mark.
We did not see any notable weather impacts this particular quarter. The big growth drivers, one that I noted was non-Hodgkin's lymphoma indications with DLBCL and NPL. We did see an increasing the total contribution of blood. A lot of that was driven by the DLBCL & MPL, which are both blood, entirely blood-based indication.
Additionally, the acceleration of our EMR integration, we added seven accounts since the end of last year, and several of those three of those are among our top 10. And so the acceleration we're seeing in utilization in those accounts certainly contribute and I am optimistic that as we continue to increase the pace of EMR integrations, we'll continue to see good contribution from those sites.

Chad Robins

Yes. I'll just kind of add to that, Mark. As we talked about -- it's not any one thing. It's a combination of these strategic factors that I kind of checked off through my prepared remarks. All those things that I've mentioned together are coming together and are executing on the strategy of blood-based testing, increasing community accounts, EMR integrations, et cetera. And obviously, with the launch of the new indications on top of that, those are starting to be a really nice uptake from the clinical community.

Mark Massaro

Sounds good. Yes, that makes perfect sense. Sorry, Chad?

Chad Robins

No, I was just saying, you know, we had started off and said we're 25%-plus growth with the emphasis on the plus. And now I think we're quite confident in our 30% growth kind of modified range.

Mark Massaro

Okay, perfect. I wanted to ask about the $4.5 million milestone payment in Q1. You are now a little over halfway towards your revised goal. So I'm just curious, is there any change to the funnel? My impression is that maybe the funnel is (technical difficulty) following the big catalysts you had last year with the [odac]. I just wanted to get a sense for how you think about the timing of recognizing these throughout the year.

Kyle Piskel

Thanks, Mark, for the color. As you know, as it relates to the funnel, I think what's happening is more and more milestones are becoming available to us. Certainly, we're adding more and realizing more from an offsetting factor. But we are having more come earlier and the realization we experienced in Q1 with a couple of milestones coming through, I think just provides us more clarity and confidence in our 2025 outlook and with potential rooms for upside even further from that.
But we wanted to kind of be prudent with all the stuff that's gone on with the FDA and just hold the dial a little cautious from that perspective. But all that being said, I think we're seeing more and more trials read out in all these things are positive for our business.

Mark Massaro

Okay, great. And last one for me. I'm Chad, you rattled off a number of large health plan, so it's nice to see that positive momentum building there. Can you give us a sense for, you know, to what extent are you contracting or are being disciplined with the higher Medicare rate that you have perhaps as a baseline? I'm just curious how that pricing and contracting discussions are going as it relates to pricing?

Chad Robins

You know, is a great question, Mark. We inject a significant amount of discipline in our pricing, meaning we will not accept a contracted rate unless it's at or very close to the Medicare rate. We have (technical difficulty)

Mark Massaro

Okay, great. Thanks, guys.

Chad Robins

You bet.

Operator

David Westenberg, Piper Sandler.

David Westenberg

Thanks for taking my question. So I wanted to ask on your so many different multiple myeloma trials. I'm guessing at a lot of times with drugs, you might see tighter testing intervals. Is there kind of a way to show better outcomes through tighter testing intervals? And I'm just like maybe thinking about that as multiple myeloma and all the clinical trial as you're in. But you know, maybe some of the other indications as well could benefit from tighter intervals.

Susan Bobulsky

Yes. That's an interesting question, David. I mean, I think what you mean by tighter, of course, is more frequent testing, if I'm correct on.

David Westenberg

Yes.

Susan Bobulsky

And so there's clearly a balance here, but in general, because, of course, the increases across the study. But in general, we are seeing greater interest in increased frequency of testing. In some indications, in particular, the kinetics of disease can be indicative of the patient's performance over time and so on. Additionally, because the FDA has -- in myeloma, they specified a certain range within which have primary endpoint can be defined. It's generally served within the 9 to 15 months of the start of therapy.
And so for that those studies, we do see people utilizing multiple time points stability, give themselves some optionality. And additionally, I think over time, we'll see that in the leukemia in DLBCL, which are increasingly blood-based indications. The frequency of the testing is certainly a conversation topic in many of these trial designs.

David Westenberg

Got it. Very helpful. And then I just wanted to ask about technology or addressing market and adjacencies. Don't get me wrong. I mean, you just recently got into DLBCL and that's a very large market. So you definitely have a large market that itself. But is there any technology or any kind of way to address other maybe blood malignancies. And then or you know, maybe that and improvements in terms of the technology in terms of getting to greater sensitivity? I mean, I'm guessing 10 to the minus eights probably really difficult to do, but maybe you can improve like the confidence interval where the --.

Susan Bobulsky

Yes. I mean, I think the way I can answer that, as I say that we are absolutely at all times looking at ways that we can continue to enhance our technology and improving the sensitivity. And to some extent, the sensitivity, the assay is simply limited by the amount of input material, right? We're also balancing that with what's practical in the queue clinic or hospital for our clinical trial.
And so we are actively looking at a number of strategies that could allow us to continue to extend the sensitivity in practical settings as well as ways that we might enhance the technology or even new technological approaches we could bring on to solve some of the problems that continue to exist on in this space.
For example, at the very strong desire in the clinic for up an entirely blood-based approach to MRD, monitoring in multiple myeloma, which is something we can support, but that there may still be ways to improve upon.

David Westenberg

Got it. Thank you very much for taking the questions and congrats on the quarter.

Susan Bobulsky

Thank you.

Chad Robins

Thanks, David.

Operator

Tejas Savant, Morgan Stanley.

Hello. This is Yuko on the call for Tejas. Thank you for taking my questions. Just regarding the FX integration, in addition to the volume lift from the EMR integrate accounts are also realizing associated cost savings, productivity gains as a result? If so, what can I mean in the context of your goal to have 50% of your ordering volume coming from EMR integration by year end? And is that factored into your updated OpEx guide as well?

Susan Bobulsky

Yes. Thanks for the question, Yuko. So it's an interesting one because, of course, most of the volume that we have going through integration is really only been going through integration for the past one to two quarters at most. But I think that where you're headed is a fair. The idea that there are potentially operational efficiency to be gained in the medium to long term as more and more of our volume goes through these integrations.
I can tell you just as an anecdote that the largest account -- our number one largest account integrated in October, and they have told us that under their measurement, they have achieved a 90% decrease in callbacks from our staff to address order discrepancies since integration.
As you can imagine, that's also not just saving them time, which is fantastic, also saving up time on that particular account. If we can achieve even half that improvement in callbacks, that other accounts and over at a scale, you can imagine that can help us either redirect our staff time or save staff time entirely. But I don't -- we have not incorporated any operational savings into our guide in 2025 at this time and we'll be continuing to monitor that. There are a number of ways by the way beyond just reducing callbacks on orders that we can leverage EMR to reduce total operational time. But those gains will be probably achieved over the next couple of years.

Chad Robins

And then one other area of potential upside is looking at revenue cycle management and being able to leverage our EMR integrations to kind of reduce have time for time to cash.

All right. That's super helpful. And then second unrelated question. With a number of headlines around cost cutting at pharma, is it possible to see more back-end loaded or milestone-based agreements with pharma versus pay-as-you-go type of contract? Have you seen any shifts and types of MRD agreements with pharma over the last six months or so?

Chad Robins

Well, actually, I've mentioned this on a couple of investor conferences. We're actually trying to, over time when contracts come up for renewal, do the opposite of that, which is to move more to recurring revenue-model business to kind of front-loaded of could have, well I'll say the fee for services sequencing component of that and move away from some of the kind of lumpy or hard to predict from a time perspective kind of milestones.
So you know, it really depends on the focus of pharma companies and indications that they're doing. But we have not seen that and don't anticipate being impacted by it.

Got it. Thank you so much.

Chad Robins

You bet.

Operator

Rachel Vatnsdal, JPMorgan.

Sebastian Sandler

Hi, this is Sebastian Sandler on for Rachel, thanks for taking the questions. I'd like to turn back to the strong sequential growth in quantity volumes. I think it was one of the best step-ups in terms of absolute test since 4Q '23 against slides the [ground] 2000.
So just looking ahead to the rest of the year, I'm wondering if the surround 2000 test step-up is appropriate. And then I'm curious if there's any further upside to the acceleration based on the number of drivers you laid out in the call.

Susan Bobulsky

Sure, thanks for the question, Sebastian. I mean, I am very pleased to see the volume growth in Q1 step-up only strengthens my confidence in our potential for the remainder of the year. As you know, when we started the year, we talked about there being an upside. And I think some of that materialize in Q1.
With this updated guidance, we still see room for upside and we do still anticipate sequential growth quarter-over-quarter, although I won't speculate on whether that the magnitude of the step-up will look the same in every single quarter. I think the reason for us being prudent on that is simply that we have a number of strategic initiatives that we are pursuing this year and that will go live in the second half. And these are just things that we haven't done before.
So we're kind of erring on the side of owned under-promise and over-deliver right now versus speculating too much about how much upside to how fast that upside can be realized. EMR is a big driver, particularly in the second half, but you know, we have to see how Flatiron launch goes. Those are in accounts that are new or emerging for us. So we are going to wait and see how quickly we can leverage that to help us with our adoption of community count.
The Epic integrations. We have a long sleeve of those plans, but not fully in our control when they get done is we need to rely on account side IT resource. So we are eager to provide further updates. But when we feel very confident, we don't see any material headwinds at this point. But it's still early in the year.

Sebastian Sandler

Understood. Thank you for the color. And then turning to the community settings called out and 40%-plus growth there. So curious if this was driven mostly by adding new accounts or deeper penetration into existing accounts? And then just curious on the outlook and the community setting for the rest of the year. Thank you.

Susan Bobulsky

Yes, you know, both we and we still we have a number of community accounts where we now have some significant volume. What we have now an account in our top 10 that is a community accounts, which by the way was one of the ones that just went live recently with an integration. In fact, our first ever non-Epic point-to-point integration, although they haven't had time to drive volume yet it just happened in April. I am as bullish about the opportunity there.
And so we do have accounts where we have significant penetration and where it's really about continuing to drive that depth. We also have accounts that are -- not have not ordered or are just getting started and so both contributed in Q1 to the continued growth. I'm really pleased with the work that our community-focused field team is doing.
I'm excited about the potential of not only our Flatiron integration to help us with the community business in the later part of the year, but also work we're doing with NeoGenomics', which albeit we will only launch in a selected group of Phase 1 accounts in the second half of this year. But in 2026 and beyond, that will be an important driver for our community footprint and our community growth pace.

Sebastian Sandler

Great. Thank you so much.

Operator

Tom Stevens, TD Cowen.

Tom Stevens

Hi, guys. Thanks for taking my question and congratulations on a really strong operating quarter.
My first one is just on the contribution of mantle cell into this year and also more broadly, just the level of new patient adds that is the number of new clonoSEQ IDs in this quarter versus 4Q. Also maybe comment on, A, the number of MCLs you expect in guidance this year and, B, the number of new patient adds as it were?

Susan Bobulsky

I think what I can say, Tom, is that in Q1, we were very pleased with the growth. We saw a 28% quarter-over-quarter growth in the contribution of MCL was 5%, which is up from about 3.5% a year ago. That indication and you know, is the smaller indication. I think one was a significant unmet need that is well suited to the value proposition of clonoSEQ.
And certainly, we're encouraged by the recurrence monitoring coverage that we achieved earlier in Q1, which while it will change our promotional strategy, we've been promoting the importance of our serial monitoring of patients off therapy on since launch. And it certainly as strengthens our resolve to make sure we drive as we drive testing in that space because we can now get paid for a larger number of these tests, which I think our clinical very, very valuable to patients.
And yes, in terms of MCL growth over time, we haven't commented specifically on the contribution of any one indication, but I do think that is possible to have higher single-digit contribution over the course of the next year or so. That is an indication, again that we believe we can penetrate quickly because of the treatment paradigm, they're being so conducive to the use of MRP.

Tom Stevens

Thank you. And just on clonoSEQ ID. I'm not sure I got that in your response.

Susan Bobulsky

Right, sorry. So more generally the contribution of clonoSEQ ID, I mean, we are starting to see an increased contribution of repeat patients. This is beyond MCL for some time at the business overall. This point, it's about a third, maybe a little less 30% of our tests are IT test and then another 20%, our first MRD's and about half of the tests are repeat MRD's. That's kind of how the business breaks out right now.

Tom Stevens

Cool. And then just one more follow-up on just kind of how you think about gross margins for the year. 62% sequencing is obviously very impressive. I know you have lots of spinning plates with our EMR initiatives into the back half. But just wondering what the public on a fee-for-service contribution to ASPs well in the quarter.
And I'm just to make sure that the MSC index transition is don't charge for Q3 and maybe why not raise the cash burn -- or reduce the cash burn guidance more than the [beat] in Q1?

Kyle Piskel

Yes. Thanks for the question, Tom. As it relates to progress on gross margins, first quarter with great. We're seeing improving -- our cost structure, improving the lab and the volume is certainly helping that. NovaSEQ is still on track for the second half of the year, and we reiterate the 5 to 8 percentage point improvement from that in the first 12 months post launch on.
So everything's kind of coming along with gross margin. So I don't have any concerns there and expect to see it continue to grow especially as we get more on the pricing favorability from both our clinical and pharma businesses.

Chad Robins

Yes. And if you recall, Tom, we talked about 70%-plus gross margins at scale. And you know, we're a little bit ahead of pace based on strong, really strong quarter.

Kyle Piskel

And on your question on cash burn, I think, yes, opportunity there to beat the number we put a guide. But again, we're just early. The exact timing of NovaSEQ launch, all those types of things, but certainly an opportunity for some additional upside and reducing our burn further, given the strong performance in Q1.

Tom Stevens

Right. So now is that like to add incremental investment in your salesforce or anything that we should be aware of?

Kyle Piskel

Nothing currently planned. We did make some investments in our revenue cycle management are reimbursed from operations team, and we believe those are paying off accretively. But no major expansions from there.

Tom Stevens

Awesome. Thank you, guys.

Chad Robins

Thanks, Tom.

Operator

Sung Ji Nam, Scotiabank.

Corey Rosenbaum

Hey, this is Corey Rosenbaum on for Sung Ji. Thanks for taking my questions and congrats on the quarter.
So first on DLBCL, do you expect the upgraded assay with the seven-fold increase in sensitivity to meaningfully change the trajectory of adoption and the indication? And could you talk about the potential use case expansion with this significant improvement in sensitivity?

Susan Bobulsky

Sure. Thanks for the question, Corey. So first off, I think that primary opportunity to leverage the enhanced assay to drive adoption. I think it's in the pharma setting rising. We've faced somewhat increased competition in recent years. And I think there is a strong desire to have a very sensitive assay [premium] in the frontline into therapy setting where a number of companies are going after study design in which patients essentially receive additional treatment of varying classes based on the fact that they are MRD in a positive, even though they've achieved conventional coal complete response by PET/CT.
So that detecting disease at those levels where imaging isn't revealing anything there requires that particular degree of sensitivity compared to other use cases. And so in the pharma setting, that's where the enhanced assay has really been an important part of our messaging in our data generation.
Now, of course, in the clinic, this is important broadly as well. And we are increasing our focus on that endotherapy use case. It has a, frankly, a synergy with what's going on in clinical trials. We anticipate that over time, these clinical trials will read out. They'll be successful the opportunities for patients to be treated with additional therapy when they don't achieve MRD negativity by the end of the standard round of, let's say, R-CHOP.
And even now there are opportunities for patients to enroll and clinical trials. And so it's two-patients benefit for us to be able to provide the most sensitive at the possible in the clinical setting as well.

Corey Rosenbaum

Great. Thank you for that insight, and I appreciate the pharma commentary throughout the call. But can you discuss the current split between later-stage clinical trials versus earlier-stage trials for the active trials underway with the MRD pharma partners?

Susan Bobulsky

The majority of our studies are in later-stage study, a later stage trial from multiple myeoloma, which is as you know, sort of [60%] of our business in the most well-developed indication. And in some of our earlier stage indications, for example, in lymphoma, we have a smaller portion of our business. The mix 10 more towards earlier-phase studies.
But in general, the use of MRD is really evolving toward registrational uses, whether primary-endpoint or secondary-endpoints status and increasingly toward the utilization of MRD as a means to direct therapy, stratify patients. And so that by nature, is helping the business evolve toward a later phase, more heavily weighted mix.

Corey Rosenbaum

Appreciate it. Thank you.

Operator

(Operator Instructions)
Andrew Brackmann, William Blair.

Maggie Bouie

Hey, everyone. This is Maggie [Bouie] on for Andrew. Thanks for taking our question.
Maybe just to start, it's nice to see a reduction in the OpEx guide for the full year. On MRD side, can you talk about any areas in particular you're seeing leverage from? And then just what other areas you think you that you could see leverage from building out from there? And then just looking further out over the next few years, where do you plan to prioritize your investment? Thank you.

Kyle Piskel

Yes. Thanks for the question. As it relates to leverage, I think we're seeing a ton of leverage across both first and foremost in the lab. Again, increasing volumes, some of the assay consolidation initiatives we put in place last year, and we're seeing the fruits of that labor payoff.
Secondarily, you know, we're seeing a ton of leverage through our volumes increasing in our field force as well. So that's, you know, all of those things are driving improvements. And while we're making investments in our reimbursement operations, at least early days from those investments seem to be paying off and gaining leverage. But we'll continue to kind of monitor that. So I think all those things are pointing to a healthy profile for this business longer term.
In terms of prioritizing our investments, I think some of this has been discussed previously in terms of what we do with our assay going forward. But we'll provide more color into that as things progress.

Susan Bobulsky

I'm sure I can just add perhaps that now a couple of things that we've talked about throughout this call will potentially be areas will be we'll see where we want to continue to invest in may ramp up investment over time. Revenue Cycle Management is the one that kind of alluded to EMR integration and related sort of technology investments that can help us increase the stickiness of our business increase our access to data that will support our ability to operate effectively. There are some potential investments we're diving there. Data generation will remain a priority for the foreseeable future in addition to some earlier stage R&D investments that we're assessing.
And then lastly, you might wonder, I didn't mention commercial field for us. We don't have any interim plans. We looked at the investment we've made and we're very comfortable with how we're covering 90% of the relevant patient population. We have reasonably sized balanced territories and reasonable numbers of HCP and account targets per rep. So we're pretty happy there. But we will evaluate whether there are additional or new deployment strategies that we might want to implement over time in response to the evolution of the market dynamics.

Maggie Bouie

Got it. Thank you. That was super helpful.
And then maybe just one on the NeoGenomics' partnership. Can you just update us on the progress you're making there and talk about what work is being done to ensure readiness for the early pilot launch and the second half of the year? And then just how you're thinking about how that will inform your full launch down the line. Thank you.

Susan Bobulsky

Sure. I'm really pleased with how that partnership has been progressing and very grateful to be working with great partners on the neo side. And the work we've been doing up until this point was to select the Phase 1 account that we wanted to target based on a variety of criteria that will allow us to gain insight to ensure that we optimize the broader national launch the beginning of next year.
We've been finalizing the TRS design and test acquisition form design. We've been designing and are creating a few direction and designing accompanying training.
And we've been in determining how samples will actually flow between the companies, how orders and reimbursement data will flow between the companies. And we've been firming up how we will manage the handoff between various members of our cross-functional teams that face our customers. So all that work will inform the second half our Phase 1 launch and will directly benefit on the longer-term national launch.

Maggie Bouie

Great. Thank you.

Operator

I am showing no further questions at this time. Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.