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Q1 net revenue of $61.8 million (up 31% YoY) and Geron reiterated full‑year Rytelo guidance of $220–240 million, noting growth is weighted to H2 2026 while gross‑to‑net rose to 21% (expected low‑mid 20s for the year) due to wider 340B use and expanded GPO contracting.
U.S. commercial execution is scaling — Rytelo now reaches about 1,450 prescribing accounts with 6% QoQ demand growth; the company is prioritizing the ~8,000‑patient second‑line lower‑risk MDS market and imetelstat’s inclusion in the NCCN chemotherapy order template positions it as the preferred second‑line option.
Pipeline and international plans: the fully enrolled Phase 3 IMpactMF trial is expected to hit its interim overall‑survival event trigger in H2 2026 (final analysis base case H2 2028), Geron is evaluating European commercialization pathways with an update planned before year‑end, and it ended Q1 with about $341 million in cash after lower operating expenses.
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Geron (NASDAQ:GERN) reported first-quarter 2026 net revenue of $61.8 million, up 31% year-over-year and 8% quarter-over-quarter, as the company continued to scale commercialization of Rytelo in the U.S. Management reiterated full-year 2026 guidance and outlined ongoing work to evaluate a European commercialization approach, while also previewing expected milestones for its Phase 3 myelofibrosis program.
Chief Executive Officer Harout Semerjian said Geron made progress on its 2026 strategic priorities in the quarter by growing Rytelo through “focused commercial execution” and advancing its European strategy “while maintaining our financial discipline.”
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Chief Financial Officer Michelle Robertson said total net revenue for the three months ended March 31, 2026 was $61.8 million, compared with $39.6 million in the prior-year period. Geron reiterated its 2026 net revenue guidance for Rytelo of $220 million to $240 million, with Robertson noting that “a greater portion of growth” is anticipated in the back half of the year.
Robertson also highlighted a shift in gross-to-net dynamics as volume increased. Gross-to-net reductions rose to 21% in the quarter from 13% a year earlier, driven by “wider 340B utilization and expanded GPO contracting.” For the rest of 2026, she said the company expects gross-to-net to be in the “low to mid 20s.”
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Chief Commercial Officer Ahmed ElNawawi said first-quarter demand grew 6% quarter-over-quarter and that prescribing accounts increased approximately 12%, expanding the company’s footprint since launch to about 1,450 accounts.
ElNawawi said Geron estimates the second-line lower-risk MDS opportunity at roughly 8,000 patients in the U.S., calling that segment the company’s “primary commercial focus” and noting the strategy is supported by current NCCN guidelines. He added that the company is seeking to reach patients “at the right point in their treatment journey when they are most likely to benefit.”
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He described three core commercial initiatives:
Targeted engagement with high-volume community accounts, prioritizing centers treating earlier-line and second-line patients while also using digital tactics for lower-volume accounts.
Increased investment in marketing channels, with an emphasis on digital, non-personal promotion, and third-party educational platforms to create a “3-D surround sound” approach.
Cross-functional account management that uses data presented at ASH 2025 to address cytopenias and position Rytelo as standard of care in appropriate second-line patients, “regardless of their RS.”
On utilization by line of therapy, ElNawawi said first- and second-line patient starts on a rolling 12-month basis were 33% in the quarter. In the Q&A, management said this compares with 30% previously (also on a 12-month look back), and characterized the trend as “continuous progress.”
Asked about the sustainability of first-quarter demand growth, Semerjian said the company plans to “continue to grow quarter over quarter,” and reiterated that Geron expects growth to accelerate in the second half of 2026, in part because changes made in the fourth quarter and first quarter “need time to kick into action.”
Executive Vice President of Research and Development and Chief Medical Officer Dr. Joseph Eid said Geron continued engaging with the hematology community to increase Rytelo’s “share of voice,” citing participation at meetings including the Aplastic Anemia & MDS International Foundation, ASCO, and the 2026 Pan-Hematology Clinical Updates meeting.
Eid said the company’s messaging has focused on ASH 2025 data “suggesting treatment-emergent cytopenias are consistent with on-target activity,” and added that community hematologists have shown increasing interest in how to incorporate those insights into clinical practice. He also pointed to a recent publication in Blood Cancer Journal examining the association between treatment-emergent cytopenia and clinical responses to Rytelo.
Geron also announced inclusion of imetelstat in the NCCN chemotherapy order template. Eid said the inclusion “positions imetelstat as an active therapeutic versus supportive care for lower-risk MDS,” and that the order templates provide guidance on administration to support standardized use across treatment centers. He noted this follows the September 2025 NCCN guideline update recommending imetelstat as the preferred second-line option in lower-risk MDS.
On real-world evidence, Eid said Geron expects “initial real-world evidence data to be available in the second half of 2026.” In response to a separate question, he also said investigator-sponsored research, including real-world data, is expected to be presented at meetings in the second half of 2026, including real-world utilization in MDS, and that early indications “reflects the IMerge data” in terms of responses.
Semerjian said Geron engaged European medical experts, made progress with health technology assessment, and conducted research to better understand the European pricing environment. He said the company expects to communicate European commercial plans before year-end “once we have clarity on pricing and market opportunities,” while also seeking to maintain “pricing integrity” in the U.S.
In the Q&A, Semerjian said Geron is exploring options to bring Rytelo to Europe and described the opportunity as “quite significant from a patient numbers perspective,” potentially in line with the U.S. He said the company is not pursuing a “very big classical buildup” model, while partnerships remain an option. He also referenced “new models and new partners in Europe” emerging to support U.S.-based biotech companies. Geron said it plans to update investors before the end of the year on where it lands and what it views as the optimal commercial path for ex-U.S. markets.
Eid provided an update on the Phase 3 IMpactMF trial of imetelstat in relapsed/refractory myelofibrosis, saying the fully enrolled trial is projected to reach the interim analysis death event trigger in the second half of 2026. Overall survival is the primary endpoint, and Eid said confidence in that endpoint is supported by survival outcomes observed in the Phase 2 IMbark trial, which informed the Phase 3 design.
From a planning perspective, Eid said Geron’s “base case” remains progressing to the final analysis in the second half of 2028, while noting an earlier positive outcome would be an upside scenario.
Asked how Geron will communicate the interim analysis, Semerjian said the company remains blinded and expects that, most likely, the data monitoring committee will recommend the trial “keep on going.” He said if the committee advises anything else, Geron would “communicate to the market accordingly.” Eid added that a Phase 3 overall survival proof-of-concept in myelofibrosis could have a positive effect on MDS awareness by reinforcing Geron’s message that the drug is disease-modifying.
Geron reported total operating expenses, including cost of goods sold, of $50.4 million in the quarter, down from $55.1 million in the prior-year period. Robertson said the decrease was primarily related to reduced headcount following a workforce reduction in December 2025.
R&D expense was $15.0 million, essentially flat with $15.1 million a year earlier. SG&A expense was $35.4 million, down from $40.0 million, which Robertson attributed to lower G&A personnel-related expenses and decreased headcount, partially offset by additional marketing investments. The company reiterated full-year 2026 total operating expense guidance of $230 million to $240 million.
Geron ended the quarter with approximately $341 million in cash, cash equivalents, restricted cash, and marketable securities, compared with $401 million at year-end 2025. Robertson attributed the decline to typical first-quarter items such as annual bonus payouts, cash severance tied to the December restructuring, and CMC investments to strengthen the Rytelo supply chain.
In closing remarks, Semerjian said Geron’s near-term priorities include growing Rytelo in the U.S., pursuing pathways to bring Rytelo to patients outside the U.S., advancing IMpactMF, and maintaining financial discipline while evaluating “opportunistic innovation” as the company seeks to build a “leading hematology company.”
Geron Corporation (NASDAQ: GERN) is a clinical-stage biotechnology company dedicated to developing and commercializing novel treatments that target telomerase, an enzyme critical to cancer cell immortality. The company's research is focused on hematologic malignancies and solid tumors, with a pipeline designed to address diseases that have historically had limited therapeutic options.
The lead product candidate, imetelstat, is a first-in-class telomerase inhibitor currently in Phase II and Phase III clinical trials for myelofibrosis and myelodysplastic syndromes.
The article "Geron Q1 Earnings Call Highlights" was originally published by MarketBeat.