In this study, we aimed to investigate treatment options and the prognosis of patients with WM in China. This retrospective study included 1141 patients diagnosed with symptomatic WM between January 2003 and December 2019 at 35 tertiary hospitals in 22 provinces of China. Fifty-four patients (7.3%) received monotherapy, 264 (36.0%) received chemoimmunotherapy, 395 (53.8%) received other combination regimens without rituximab, and 21 (2.9%) received ibrutinib. Using a multivariable Cox regression model, age > 65 years old, platelets <100 x 10(9)/L, serum albumin <3.5 g/dl, beta 2 microglobulin concentration >= 4 mg/L and LDH >= 250 IU/L predicted poor OS. In summary, our study showed that frontline treatment choices for WM are widely heterogeneous. We validated most of the established prognostic factors in the rIPSS (age >65 years, LDH >= 250 IU/L, ALB <3.5 g/dl and beta 2 microglobulin >= 4 mg/L) together with PLT <= 100 x 10(9)/L indicate a poor prognosis for patients with WM.