While the SP4 locus did not replicate in the combined COG European and CCLS Latinos replication datasets (Pmeta = 0.075), it was nominally associated with ALL risk in the COG sample, with a similar direction and magnitude of effect (OR = 1.15, 95% CI: 1.02–1.31, P = 0.025). This evidence concerns the gene SP4 and acute lymphoblastic leukemia.