Earnings Call Transcript - ADPT Q1 2025

Operator, Operator

Good day, and thank you for standing by. Welcome to the Adaptive Biotechnologies First Quarter 2025 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speakers' presentation, there will be a question-and-answer session. 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, Head of Investor Relations

Thank you, Anton, and good afternoon, everyone. I would like to welcome you to Adaptive Biotechnology's first quarter 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 conducting a live webcast of this call and will be referencing a slide presentation that has been posted to the Investors section of our corporate website. During the call, management will make projections and other forward-looking statements within the meaning of federal securities laws regarding future events and the 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 and Co-Founder, and Kyle Piskel, our Chief Financial Officer. Additional members of the management team will be available for Q&A. With that, I'll turn the call over to Chad. Chad?

Chad Robins, CEO

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 the 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, a lower operating expense range; and three, a lower annual cash burn. Kyle will provide more details during his remarks. Of note, our full-year outlook has minimal exposure to tariffs, trading policy updates, and NIH 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 MRD business on Slide 5. clonoSEQ clinical revenue in the first quarter grew 55% versus the prior year. Tests delivered reached a new record high of over 23,000 in the quarter, representing a 36% increase versus the prior year and a 10% increase sequentially. Growth was once again observed in all reimbursed indications. Multiple myeloma continues to be the largest contributor of U.S. clonoSEQ 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 tests in the U.S. versus 39% a year ago. This increase was primarily driven by strong growth in DLBCL and MCL. Tests in the community grew 42% versus the 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 in DLBCL. The number of ordering healthcare providers grew 31% from the prior year and is now over 3,400. And our pace of EMR integrations is accelerating. We now have 27 live integrations, including five of our top 10 accounts. We expect to add at least five 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 have 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 growth of 11% versus the prior year. This quarter, we also recognized $4.5 million in regulatory milestones. We continue to see significant momentum following the ODAC recommendation in multiple myeloma last year. As you can see from the chart, over 60% of our portfolio today is in multiple 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 endpoint. 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 in 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 with over 45% of clonoSEQ testing done in blood. We are on track with EMR integrations, including the OncoEMR 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 spanning 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 focuses 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 our 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 with a digital model that can rapidly and accurately predict TCR-antigen binding. This has the potential to meaningfully reduce both the time and cost of selecting the best TCRs to include in a cancer cell therapy, among other future 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 strategies, is 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 this 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, CFO

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 and 17% from the Immune Medicine. MRD revenue grew 34% versus the 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 U.S. grew approximately 14%. MRD pharma revenue grew 7% versus the prior year to $15.2 million, inclusive of $4.5 million in milestones. Immune Medicine revenue was $8.7 million, down 6% from 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 the 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 the 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 spend 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 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 spend. Immune Medicine adjusted EBITDA loss was also improved 21% versus Q1 of last year, due to reductions in operating spend. Total company adjusted EBITDA was a loss of $12.7 million in the first quarter compared to $28.2 million in the prior year. Interest expense from our royalty financing agreement with OrbiMed 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 MRD 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 volumes 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 spend 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, 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 primarily driven by higher than expected MRD revenue and reduced unallocated corporate expenses. We now expect approximately 24% of this year's cash burn to come from the MRD business and still anticipate burn from the Immune Medicine business to be between $25 million and $30 million, with 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, CEO

Thanks, Kyle. Our strong first quarter results underscore the focus, agility, and execution of our team. We're 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 the operator and open it up for questions.

Operator, Operator

Thank you. At this time, we'll conduct a question-and-answer session. Our first question comes from Matt Sykes from Goldman Sachs.

Unidentified Analyst, Analyst

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

Chad Robins, CEO

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

Susan Bobulsky, Executive

Thanks for the question, Will. Yes, we're seeing sequential growth across all indications. We had a particularly strong quarter for our lymphoma indications, DLBCL, and mantle cell lymphoma. You'll recall that we've launched the mantle cell indication just in Q4. So, we're seeing a nice conversion of the promotional effort over the last two quarters. And then in DLBCL, we launched an enhanced version of our assay and also saw the availability of our assay in New York State under CLEP approval become live in Q1. So, a number of factors 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 MCL, 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.

Unidentified Analyst, Analyst

That's super helpful. And then just as a follow-up, you touched on the EMR integration on the call. I know last quarter, 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 uptick you're seeing there?

Susan Bobulsky, Executive

I do have a few more updates that 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 five of our top 10 largest accounts integrated, several of 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. 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 more than doubled over the past year. Among the newer sites that went live, let's say, it 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 those same sites a quarter immediately preceding integration. So, we are continuing to see acceleration. And I think particularly in those large accounts, those growth rates are quite impressive.

Unidentified Analyst, Analyst

Really impressive results. Thank you for the color.

Chad Robins, CEO

You bet.

Operator, Operator

Thank you. Our next question comes from Mark Massaro from BTIG. Please go ahead.

Mark Massaro, Analyst

Thank you for the questions. I wanted to begin by highlighting the strong performance in our core clonoSEQ volume, which saw an increase of about 2,000 tests sequentially. Other labs in the industry have mentioned the impact of weather, estimating around 100 to 150 basis points across various reference labs. I'm interested in learning how you achieved this growth and where it originated. I know there's been a larger contribution from ClonoSeq blood, but could you clarify if weather had any effect in the first quarter?

Susan Bobulsky, Executive

Sure. I can take that. Thanks, Mark. We did not see any notable weather impact this particular quarter. The main growth drivers I noted were non-Hodgkin's lymphoma indications, specifically DLBCL and MCL. We observed an increase in the overall contribution from blood, largely driven by DLBCL and MCL, which are completely blood-based indications. Additionally, we accelerated our EMR integrations, adding seven accounts since the end of last year, three of which are among our top ten. The increased utilization in those accounts contributed significantly, and I am optimistic that as we continue to enhance the pace of EMR integrations, we will see continued strong contributions from those sites.

Chad Robins, CEO

Yes. I would like to add to that, Mark. As we've discussed, it's not just one factor; it's a mix of strategic elements that I outlined in my prepared remarks. All the points Susan mentioned are coming together as we execute our strategy of increasing blood-based testing and expanding community accounts and EMR integrations. Additionally, with the launch of the new indications, we're starting to see positive uptake from the clinical community.

Mark Massaro, Analyst

Sounds good. So you...

Chad Robins, CEO

If that makes sense.

Mark Massaro, Analyst

Yes, yes that makes perfect sense. Sorry Chad.

Chad Robins, CEO

No, I was just saying we had started off and said 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, Analyst

Okay. Yes. 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 growing following the big catalyst 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, CFO

Thanks, Mark. This is Kyle. 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 room for upside even further from that. But we want to kind of be prudent with all the stuff that's going on with the FDA and just hold the guidance a little cautiously from that perspective. But all that being said I think we're seeing more and more trials read out and all these things are positive for our business.

Mark Massaro, Analyst

Okay. Great. And last one for me. Chad, you rattled off a number of large health plans. So it's nice to see that positive momentum building there. Can you give us a sense for to what extent are you contracting or 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, CEO

Yes. No, it's 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 keep our ASP low.

Mark Massaro, Analyst

Okay. Great. Thanks, guys.

Chad Robins, CEO

You bet.

Operator, Operator

Thank you. Our next question comes from David Westenberg from Piper Sandler. Please go ahead.

David Westenberg, Analyst

Hi. Thanks for taking my question. I wanted to ask about the various multiple myeloma trials. Are you noticing that with some drugs, there could be advantages to having tighter testing intervals? I'm considering this in relation to multiple myeloma and the clinical trials you're involved in, as well as potentially other indications that might also benefit from tighter intervals.

Susan Bobulsky, Executive

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

David Westenberg, Analyst

Yes.

Susan Bobulsky, Executive

There is definitely a balance to consider. In general, we are observing an increased interest in more frequent testing, which does raise the cost of the study. Some disease indications, particularly the kinetics of disease, can provide insights into a patient's progress over time. Furthermore, the FDA has outlined a specific range for defining a primary endpoint in myeloma, typically between 9 to 15 months from the start of therapy. This has led to researchers utilizing multiple time points in studies to allow for more options. Over time, we expect to see similar trends in leukemias and DLBCL, which are increasingly blood-based conditions. The topic of testing frequency is being actively discussed in many of these trial designs.

David Westenberg, Analyst

Got it. No, very helpful. I wanted to ask about technology or addressing market adjacencies. You recently entered the DLBCL market, which is quite large, so you certainly have significant market potential. Are there any technologies or methods to address other blood malignancies or improvements that could enhance sensitivity? Achieving a sensitivity of 10 to the minus eight seems very challenging, but is there potential to improve the confidence interval?

Susan Bobulsky, Executive

Yes. I mean, I think the way I can answer that is to say that we are absolutely at all times looking at ways that we can continue to enhance our technology improving the sensitivity. To some extent, the sensitivity of the assay is simply limited by the amount of input material, right? We're also balancing that with what's practical in the clinic or practical 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 to solve some of the problems that continue to exist in the space. For example, there's a very strong desire in the clinic for 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, Analyst

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

Susan Bobulsky, Executive

Thank you.

Chad Robins, CEO

Thanks, David.

Operator, Operator

Thank you. Our next question comes from Tejas Savant from Morgan Stanley. Please go ahead.

Yuko Oku, Analyst

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

Susan Bobulsky, Executive

Thanks for the question, Yuko. It's an interesting topic because most of the volume we have going through integration has only been doing so for the past one to two quarters at the most. I believe your perspective is valid. There are likely operational efficiencies to be gained in the medium to long term as more of our volume flows through these integrations. As an example, our largest account integrated in October and they reported a 90% reduction in callbacks from our staff regarding order discrepancies since the integration. This not only saves them time, which is fantastic, but it also saves us time on that account. If we can achieve even half that reduction in callbacks at other accounts on a larger scale, it could help us either redirect our staff time or save it entirely. However, we have not included any operational savings in our guidance for 2025 at this point, and we will continue to monitor this. There are various ways, beyond just reducing callbacks, that we can use EMR to lower total operational time, but those improvements are likely to be realized over the next couple of years.

Chad Robins, CEO

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

Yuko Oku, Analyst

Got it. That's super helpful. And then a 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 contracts? Have you seen any shifts in types of MRD agreements with pharma over the last six months or so?

Chad Robins, CEO

Actually, I've mentioned this at 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 a recurring revenue model business to kind of front-load the kind of I'll say the fee-for-service or sequencing component of that and move away from some of the kind of lumpier, hard to predict from a time perspective, kind of milestones. So, it really depends on the focus of pharma companies and the indications that they're doing. But no, we have not seen that and don't anticipate being impacted by it.

Yuko Oku, Analyst

Got it. Thank you so much.

Chad Robins, CEO

You bet.

Operator, Operator

Thank you. Our next question comes from Rachel Vatnsdal from JPMorgan. Please go ahead.

Sebastian Sandler, Analyst

Hi. This is Sebastian Sandler on for Rachel. Thanks for taking the question. I'd like to turn back to the strong sequential growth in clonoSEQ volumes seen. I think it was one of the best step-ups in terms of absolute tests since 4Q '23 looking at the slides I think around 2000. So just looking ahead to the rest of the year, I'm wondering if this around 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, Executive

Sure. Thanks for the questions, Sebastian. I mean I am very pleased to see the volume growth in Q1. The 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 materialized in Q1. And 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 the magnitude of the step-up will look the same 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 faring on the side of under-promise and over-deliver right now versus speculating too much about how much upside, how fast that upside can you realize? EMR is a big driver particularly in the second half, but we have to see how the Flatiron launch goes. Those are in accounts that are new or emerging for us. So, we're going to wait and see how quickly we can leverage that to help us with adoption of those community accounts. The EPIC integrations, we have a long slate of those plans, but it's not fully in our control when they get done since we need to rely on account side IT resources. So, we'll be eager to provide further updates, and we feel very confident; we don't see any material headwinds at this point, but it's still early in the year.

Sebastian Sandler, Analyst

Understood. Thank you for the color. And then turning to the community setting. You called out, I think, 40% plus growth there. So I'm curious if this was driven mostly by adding new accounts or deeper penetration into existing accounts. And then just curious on the outlook in the community setting for the rest of the year. Thank you.

Susan Bobulsky, Executive

Yes, both. We have several community accounts generating significant volume, including one that recently became part of our top 10 after launching our first non-EPIC point-to-point integration in April. While it hasn't yet impacted volume, I am optimistic about the potential there. We have accounts with strong penetration that we aim to deepen further, as well as new accounts that are just starting out. Both factors contributed to our growth in Q1. I'm pleased with the efforts of our community-focused field team and excited about the potential of our Flatiron integration to boost community business later this year, along with our collaboration with NeoGenomics, which will launch in select Phase 1 accounts in the second half of this year. Looking ahead to 2026 and beyond, this will be crucial for expanding our community presence and growth rate.

Sebastian Sandler, Analyst

Great. Thank you so much.

Operator, Operator

Thank you. Our next question comes from Tom Stevens from TD Cowen. Please go ahead.

Tom Stevens, Analyst

Hi, guys. Thanks for taking my question and congratulations on a really strong operating quarter. My first one is just on the contribution of kind 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. I was hoping you could 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, Executive

I think I can share that in Q1, we were very pleased with our growth, reporting a 28% increase quarter-over-quarter. The contribution from mantle cell lymphoma (MCL) was 5%, up from about 3.5% a year ago. While this is a smaller indication, it presents a significant unmet need that aligns well with the value proposition of clonoSEQ. We are also encouraged by the coverage for recurrence monitoring that we secured earlier in Q1. Although it won't alter our promotional strategy, we have emphasized the importance of continuous monitoring of patients off therapy since the launch. This development reinforces our commitment to drive testing in this area since we can now receive reimbursement for more tests, which are clinically valuable for patients. Regarding MCL growth over time, we haven't specifically commented on the contribution from any single indication, but I believe we could see a higher single-digit contribution over the next year or so. This is an indication that we can likely penetrate quickly due to the treatment paradigm being very supportive of using minimal residual disease (MRD) testing.

Tom Stevens, Analyst

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

Susan Bobulsky, Executive

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. Of course, I'm talking about the business overall. At this point, I think about a third, maybe a little less 30% of our tests are ID tests, and then another 20% are first MRDs and about half of the tests are repeat MRDs. That's kind of how the business breaks out right now.

Tom Stevens, Analyst

Cool. And then just one more follow-up on how you're thinking about gross margins for the year. 62% sequencing is obviously impressive. I know you have many initiatives with EMR planned for the second half. But I'm curious about the fee-for-service contribution to ASPs in the quarter. Also, is the NovaSeq X transition still on track for Q3? And why not reduce the cash burn guidance more than the beat in Q1?

Kyle Piskel, CFO

Thanks for the question, Tom. Regarding our progress on gross margin, the first quarter was very positive. Our cost structure in the lab is improving, and the increased volume is certainly contributing to that. The NovaSeq is still on schedule for the second half of the year, and we reaffirm our expectation of a 5 to 8 percentage point improvement within the first 12 months after launch. Overall, things are progressing well with gross margins, and I have no concerns in that area. I anticipate continued growth, especially as we gain more pricing advantages from our clinical and pharmaceutical businesses.

Chad Robins, CEO

Yeah. If you remember, Tom, we discussed achieving over 70% gross margins at scale, and we are slightly ahead of schedule due to a very strong quarter.

Kyle Piskel, CFO

Regarding your question about cash burn, we believe there is a chance to exceed the figures we included in our guidance. However, it's still early to determine the precise timing of the NovaSeq launch and other related factors. Nevertheless, given our strong performance in the first quarter, there is certainly potential for further reductions in our burn rate.

Tom Stevens, Analyst

So, is there any incremental reinvestment in the sales force that we should be aware of?

Kyle Piskel, CFO

Nothing is currently planned. We have made some investments in our revenue cycle management and reimbursement operations team, and we believe those are yielding positive results. However, there are no major expansions from that point.

Tom Stevens, Analyst

Awesome. Thank you, guys.

Kyle Piskel, CFO

Thanks, Tom.

Operator, Operator

Thank you. Our next question comes from Sung Ji Nam from Scotia Bank. Please go ahead.

Corey Rosenbaum, Analyst

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 sevenfold increase in sensitivity to meaningfully change the trajectory of adoption in the indication? And could you talk about the potential use case expansions with the significant improvement in sensitivity?

Susan Bobulsky, Executive

Sure. Thanks for the question, Corey. So first off, I think the primary opportunity to leverage the enhanced assay to drive adoption, I think, is in a pharma setting, where as you know, we've faced somewhat increased competition in recent years. And I think there is a strong desire to have a very sensitive assay, particularly in the front line end of therapy setting, where a number of companies are going after study designs in which patients essentially receive additional treatment of varying classes based on the fact that they are MRD positive, even though they've achieved conventional complete response by PET CT. So detecting that disease at those levels where imaging isn't revealing anything there requires a 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 and our data generation. Of course, in the clinic, this is important broadly as well. And we are increasing our focus on that end-of-therapy use case as, 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. There'll be opportunities for patients to be treated with additional therapy when they don't achieve MRD negativity by the end of the standard round of RCHOP. And even now, there are opportunities for patients who enroll in clinical trials. And so it's to patients' benefit for us to be able to provide the most sensitive assay possible in the clinical setting as well.

Corey Rosenbaum, Analyst

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, Executive

The majority of our studies are focused on later-stage trials for multiple myeloma, which represents over 60 percent of our business in the most developed indication. In contrast, we have a smaller share in earlier stage indications like lymphoma, where the emphasis is on earlier phase studies. Generally, the approach to minimal residual disease (MRD) is evolving towards registrational uses, whether as a primary or secondary endpoint, and is increasingly being used to guide therapy and stratify patients. This shift is naturally steering the business towards a greater focus on later-phase studies.

Corey Rosenbaum, Analyst

Appreciate it. Thank you.

Operator, Operator

Thank you. Our next question comes from Andrew Brackmann from William Blair. Please go ahead.

Maggie Boeye, Analyst

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

Chad Robins, CEO

Yes. Thank you for the question. Regarding leverage, we are experiencing significant leverage in the business, particularly in the lab with increased volumes and the asset consolidation initiatives we implemented last year, which are now yielding results. Additionally, we are seeing substantial leverage from rising volumes in our field force as well. All these factors are contributing to improvements. While we are investing in our reimbursement operations, early indications suggest those investments are beginning to gain traction, and we will keep an eye on it. Overall, these developments indicate a strong long-term outlook for the business. As for prioritizing our investments, we have previously discussed our plans for our assay moving forward, and we will share more details as we make progress.

Susan Bobulsky, Executive

Sure. I can add that there are a couple of areas we've discussed during this call where we plan to continue investing and may increase our investment over time. Revenue cycle management is one area mentioned by Kyle. We'll also explore EMR integration and related technology investments to enhance our business's stickiness and improve access to data for effective operations. We're evaluating potential investments in that area as well. Data generation will be a priority for the foreseeable future, along with some early-stage R&D investments that we'll be looking into. Lastly, regarding the commercial field force, we currently have no near-term plans for changes. We've analyzed our investment and feel comfortable covering 90% of the relevant patient population with our adequately sized territories and a reasonable number of healthcare professional and account targets per representative. We are satisfied with our current setup but will consider new deployment strategies over time as the market evolves.

Maggie Boeye, Analyst

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 in the second half of this year? And then just how you're thinking about how that will inform your full launch down the line? Thank you.

Susan Bobulsky, Executive

I'm really pleased with the progress of our partnership and grateful to be collaborating with great partners on the Neo side. We have been focused on selecting the Phase 1 accounts we want to target based on various criteria that will help us gain insights for optimizing the broader national launch early next year. We are finalizing the design of the test requisition form and creating field direction as well as training for the company. We are also determining how samples, orders, and reimbursement data will flow between our companies, and we are solidifying how to manage handoffs among our cross-functional teams that interact with customers. All of this work will inform the second half of the Phase 1 launch and will directly support the longer-term national launch.

Maggie Boeye, Analyst

Great. Thanks so much.

Operator, Operator

Thank you. 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.